Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents

Abstract

Background: Malignant gastrointestinal obstruction is a common preterminal event that is often treated surgically. The use of self-expandable stents to treat malignant gastric and small intestinal strictures is limited. We evaluated the feasibility, effectiveness, safety and outcome of self-expandable metal stents in providing palliative care for patients with inoperable malignant strictures of the stomach and small intestine.

Methods: Eleven consecutive patients with complete or near complete gastric or small intestinal obstruction were treated palliatively with self-expandable metal stents. Contrast radiographs were taken before and after insertion in all patients to confirm patency. Nineteen stents were placed using biliary guidewires and catheters under endoscopic and fluoroscopic guidance. Diets were modified as needed. Success was defined both technically and clinically.

Results: Technical and clinical success with improvement in the patient's oral diet was achieved in ten patients (91%). The one failure was caused by severe anastomotic angulation and distal luminal obstruction. During the follow-up of 5 to 294 days (mean 77 days) there were no major complications except that the stents occluded in four patients.

Conclusion: Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents is a feasible, effective, and safe alternative to operation.