Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study

Abstract

Background: Malignant gastric outlet obstruction is often treated by stent placement.

Objective: To investigate the outcomes of stent placement in the palliative treatment of malignant neoplasms.

Design: Prospective, observational, multicenter registry.

Setting: Six tertiary care centers in 5 countries.

Patients: A total of 108 adult patients with malignant gastric outlet obstruction.

Interventions: Placement of an uncovered, self-expandable, metal duodenal stent.

Main outcome measurements: The primary endpoint was stent patency at 14 days after stent implantation. Secondary endpoints included stent patency at 1, 2, 3, and 6 months, gastric outlet obstruction scoring system (GOOSS) scores at 14 days and 1, 2, 3, and 6 months after stent deployment, technical success, adverse events, and patient survival (ie, confirmed duration of the implant).

Results: Technical success was achieved in 99.1% of stent placements. Stent patency at 14 days was 94.6%. Kaplan-Meier estimates of stent patency were 92.9% at 1 month, 86.2% at 2 months, 81.9% at 3 months, and 63.4% at 6 months. At 14 days, GOOSS scores increased by a median of 1 point. The overall GI adverse event rate was 32.4%; however, the stent-related adverse event rate was 19.4%. The median implant duration was 47 days (range 0-195 days).

Limitations: Observational study, no control group.

Conclusions: Duodenal stent placement resulted in prompt relief of malignant gastric outlet obstruction and improved GOOSS scores. (

Clinical trial registration number: NCT00991614.).

Keywords: GJJ; GOOSS; gastric outlet obstruction scoring system; gastrojejunostomy.