title: Safety and benefits of self-expandable metallic stents with chemotherapy for malignant gastric outlet obstruction.
abstract: OBJECTIVE
  The influence of chemotherapy on placement of self-expandable metallic stents (SEMS) for malignant gastric outlet obstruction (MGOO) has not been evaluated extensively. We investigated the influence of chemotherapy on the clinical outcomes of SEMS placement for MGOO.
  
  
  METHODS
  A total of 152 cancer patients with MGOO from a university hospital and affiliate hospitals were included. The patients were classified according to chemotherapy status and evaluated for palliative efficacy and safety of SEMS placement.
  
  
  RESULTS
  Technical success rate, time to oral intake, and parameters indicating improvement of physical condition did not differ between the with- and without-chemotherapy groups after stent placement. Re-intervention and stent migration were significantly more frequent in the with-chemotherapy group than in the without-chemotherapy group after stent placement (re-intervention, 32.4% vs 7.8%, P = 0.0005; stent migration, 13.5% vs 1.7%, P = 0.0097). The frequency of adverse events did not differ between the with- and without-chemotherapy groups. Although chemotherapy after stent placement was an independent predictive factor for shortening the stent patency period (hazard ratio [HR], 3.10; P = 0.0264), the use of additional stents facilitated uneventful recovery and further prolonged survival time (HR, 0.60; P = 0.0132).
  
  
  CONCLUSIONS
  Various cancer patients with MGOO can undergo SEMS placement safely regardless of chemotherapy, and concurrent chemotherapy after stent placement can prolong survival time, although re-intervention and stent migration may be increased.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takada
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: drug therapy; malignant gastric outlet obstruction; neoplasm; palliative care; stent