title: Non-centralised service for palliative stenting of malignant gastric outlet obstruction.
abstract: BACKGROUND
  Malignant gastric outlet obstruction (GOO) is a common, debilitating and frequently pre-terminal symptom of intra-abdominal malignancies. Traditional 'gold standard' treatment has been palliative surgical gastro-enterostomy. Over the past two decades, use of self-expanding metallic stents (SEMSs) to relieve malignant GOO has become first-line treatment. We present the results from a single district general hospital in the UK in which malignant GOO was treated with SEMSs over a six-year period.
  
  
  METHODS
  All patients who underwent palliative stenting for malignant gastro-duodenal tumours in our centre for six years up to January 2013 were assessed retrospectively. Outcomes were assessed with regard to: technical and clinical success; return to oral nutrition; prevalence of complications and re-intervention; and overall survival.
  
  
  RESULTS
  Thirty-two stents were implanted in 29 patients. Technical success was 100%. Clinical success and return to oral nutrition were both 91%. The prevalence of complications was 16%. The prevalence of re-intervention was 13%. Mean survival was 91 (range, 5-392) days. Median wait from decision to implant a stent to stent implantation was 1 (range, 0-14) day. Overall, 25 covered and nine uncovered stents were implanted.
  
  
  CONCLUSIONS
  Stent implantation for GOO in this patient group is an established and preferable alternative to surgical intervention. Much of the treatment for malignancies of the upper gastrointestinal tract has now been centralised. Our data showed comparable results with published data for these procedures, with a high prevalence of success and low prevalence of major complications. It is of considerable benefit to these patients not to have to travel to a regional centre for stent implantation.
authors.affiliation: Department of General Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Calow, Chesterfield, Derbyshire, S44 5BL, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Trotter
authors.forename: R
authors.initials: R
authors.lastname: Balamurugan
authors.forename: K L
authors.initials: KL
authors.lastname: Dear
authors.forename: G M
authors.initials: GM
authors.lastname: Naylor
authors.forename: N J
authors.initials: NJ
authors.lastname: Everitt
authors.forename: K
authors.initials: K
authors.lastname: Ravi
mesh_terms: D017219:Gastric Outlet Obstruction / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*