title: An assessment of radiologically inserted transoral and transgastric gastroduodenal stents to treat malignant gastric outlet obstruction.
abstract: BACKGROUND
  Self-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist.
  
  
  METHODS
  Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed.
  
  
  RESULTS
  Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001).
  
  
  CONCLUSIONS
  The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.
authors: Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors: Bethany H T
authors: BHT
authors: Miller
authors: Department of Upper Gastrointestinal Surgery, The New Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK.
authors: Ewen A
authors: EA
authors: Griffiths
authors: Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors: Kishore G
authors: KG
authors: Pursnani
authors: Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
authors: Jeremy B
authors: JB
authors: Ward
authors: Department of Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley and South Ribble Hospital, Chorley, PR7 1PP, UK. Robert.Stockwell@lthtr.nhs.uk.
authors: Robert C
authors: RC
authors: Stockwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D005770:Gastrointestinal Neoplasms / Q000150:complications*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000000981:diagnostic imaging; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome