Management of Malignant Gastric Outlet Obstruction with Expandable Metallic Stent Placement

Abstract

Background: To investigate the efficacy and procedural skills of metallic stent placement for malignant gastric outlet obstruction.

Methods: Nine patients with malignant gastric outlet obstruction were performed metallic stent placement. Two stent placement methods were employed, the first, stents were placed under guidance of endoscopy in 7 patients (stent introducer: 140 mm in length and 4-6 mm in diameter); the second, duodenal stents were placed through endoscopic biopsy channel (3.2 or 4.2 mm in diameter) in 2 patients.

Results: The stent placement succeeded at the first attempt in all 9 patients. Among the 9 patients, 3 placed with 2 x 10 cm stents, and 6 with 2 x 8 cm stents. Pylorus stents, duodenal stents, and esophageal stents were placed in 2 patients, 6 patients and 1 patient, respectively. Stents expanded about 90% confirmed by fluoroscopy 24 - 48 h after the procedure. the patients started liquid food 24 h after stent placement. The common post-procedural complications included nausea, vomiting, upper digestive tract hemorrhage and upper abdominal pain. Post-procedural obstructive jaundice occurred in 1 patient. During the 3 months follow-up, no stent migration, removal and occlusion occurred. Of the 9 patients, 3 survived 10-15 days and 2 survived 1-2 months, the rest 4 patients survived 3 months. The mean stent patency was 53.4 days.

Conclusions: Expandable metallic stents placed in patients with malignant obstruction of gastric outlet effectively palliate the obstructive symptoms. Technical skills play important roles in stent placement in treatment of malignant gastric outlet obstruction, and the efficacy of metallic stent placement is associated with the location of metallic stents and therapeutic indications.

Keywords: efficacy; expandable metallic stent; gastric cancer; gastric outlet; obstruction; placement; technique skills.

Figure 1

Stents used in this study. a, Duodenal stent; b, pylorus stent.

Figure 2

Stent delivery system. (a), stent delivery system; (b), the front tip of the delivery system; (c), the handler of the delivery system.

Figure 3

Expandable metallic stent placement for malignant gastric outlet obstruction under endoscopy in a male patient (46 years old, progressive gastric pylorus cancer). (a), stricture of the pylorus; (b), upper part of the pylorus stent; (c), middle part of the pylorus stent; (d), lower part of the pylorum stent.