title: Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis.
abstract: OBJECTIVE
  To evaluate the efficacy of self-expanding metal stents (SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis (PC).
  
  
  METHODS
  We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.
  
  
  RESULTS
  In most cases, obstruction was caused by pancreatic (47%) or gastric cancer (23%). Technical success was achieved in 96.8% (60/62), clinical success in 79% (49/62) of all patients. Signs of carcinomatosis were identified in 27 patients (43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients (11.2%) and suspected by CT, MRI or ultrasound in 20 patients (32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease (66.7%vs88.6%,P= 0.036). There was no significant difference in overall survival between patients with or without PC (median 48 dvs70 d,P= 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure (median 14.5 dvs75 d,P= 0.0003).
  
  
  CONCLUSIONS
  Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rademacher
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bechtler
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Hartmann
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Striegel
authors.affiliation: Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Jakobs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000401:mortality / Q000556:secondary; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017219:Gastric Outlet Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000401:mortality / Q000556:secondary; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Endoscopy; Gastric outlet obstruction; Palliation; Peritoneal carcinomatosis; Self-expanding metal stents