Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction
ABSTRACT Endoscopically inserted self-expandable metal stents (SEMSs) are used to palliate malignant gastric outlet obstruction (GOO). Peritoneal disease is considered a relative contraindication to SEMS placement given the risk of multifocal obstruction.
To evaluate the success of SEMSs placed in patients with GOO with carcinomatosis.
Retrospective review of patients who underwent SEMS placement for malignant GOO.
Large, urban cancer center.
A total of 215 patients who were scheduled for SEMS placement for GOO.
Technical success, clinical success, early and late SEMS failure, and complications.
Technical success was achieved in 192 of 201 patients (95.5%). Of the 9 patients who did not achieve technical success, 6 had carcinomatosis. Among the 116 patients (60%) with carcinomatosis, clinical success was achieved 94 of them (81%). Of these 94 patients, 17 (18%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Among the 76 patients (40%) without carcinomatosis, clinical success was achieved in 64 of them (84%). Of these 64 patients, 17 (27%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Complication rates were similar for both groups.
This was a retrospective review with experienced clinicians selecting patients whom they thought would benefit from SEMS placement.
This is the first study to evaluate the effect of carcinomatosis on the technical and clinical success of SEMSs in the palliation of malignant GOO. We found clinical outcomes comparable to those without peritoneal disease. Carcinomatosis should not be considered a contraindication to SEMS placement in selected patients with malignant GOO.
Article: Upper gastrointestinal tumorsEndoscopy 04/2012; 44(4):371-4. DOI:10.1055/s-0032-1306779 · 5.20 Impact Factor
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ABSTRACT: The objective of our study was to assess the technical feasibility and clinical effectiveness of expandable metallic stent placement in patients with nonanastomotic malignant jejunal obstruction after total gastrectomy with esophagojejunostomy. We retrospectively analyzed data from 21 patients with malignant jejunal obstruction after total gastrectomy with esophagojejunostomy who received one of two types of expandable metallic stent. Clinical effectiveness was assessed using the following variables: technical and clinical outcomes, complications, dysphagia scores before and after stent placement, patient survival, and stent patency. Complications with related interventions were evaluated and compared between the two stent types. Stent placement was technically successful in 20 of the 21 patients (95%) with 19 of 20 patients (95%) showing symptomatic improvement. Type A stents were used in 10 patients and type B stents in the remaining 10 patients. Complications occurred with seven of 20 stents (35%) and involved stent migration (n = 3), tumor overgrowth (n = 3), or pain (n = 1). The dysphagia score before stent placement (mean ± SD, 3.2 ± 0.5) had improved by 3 days after stent placement (1.3 ± 0.9, p < 0.001) and was maintained compared with the initial score up to 1 month (1.7 ± 1.1, p < 0.001) and 3 months (2.1 ± 1.5, p = 0.021) after stent placement. The median patient survival and stent patency were 114 and 46 days, respectively. The type of stent was not significantly related to complications (p = 0.350). Placement of expandable metallic stents to treat nonanastomotic malignant jejunal obstruction in patients who have undergone total gastrectomy with esophagojejunostomy is feasible and clinically effective.American Journal of Roentgenology 05/2012; 198(5):1203-7. DOI:10.2214/AJR.11.7419 · 2.74 Impact Factor
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ABSTRACT: Background: Gastrointestinal (GI) luminal obstruction or malignant biliary obstruction (MBO) is not a rare condition in gastric cancer patients with peritoneal metastasis. The role of endoscopic or percutaneous interventions is not fully elucidated in this setting. Methods: 123 patients with unresectable or recurrent gastric adenocarcinoma with peritoneal metastasis receiving intravenous and intraperitoneal paclitaxel combined with S-1 were retrospectively studied. Safety and efficacy of interventions for GI luminal obstruction and MBO were evaluated. Results: 27 patients (22%) underwent GI luminal and/or biliary interventions; GI luminal alone in 10, biliary alone in 10 and both in 7, with technical success rate of 100%. Clinical success rate was 65% in self-expandable metallic stents (SEMS) placement for GI luminal obstruction. ECOG performance status (PS) was prognostic of clinical success in GI luminal stenting (100% in PS of 1 vs. 14% in PS of 2-3, P <0.001). Biliary drainage (endoscopic SEMS placement in 4 and percutaneous transhepatic biliary drainage in 12) relieved obstructive jaundice in 94%. Six complications were observed; 4 after GI luminal stenting (2 occlusion and 1 aspiration pneumonia) and 2 after biliary stenting (1 cholangitis and 1 cholecystitis). Median survival after the initial intervention was 5.7 months. PS at interventions was prognostic of survival after interventions (12.3 months in PS of 1 vs. 2.2 months in PS of 2 or 3, P <0.001). Conclusion: Endoscopic or percutaneous interventions for GI luminal obstruction or MBO were feasible and effective in gastric cancer patients with peritoneal dissemination receiving combination chemotherapy. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.Journal of Gastroenterology and Hepatology 07/2012; 27(12). DOI:10.1111/j.1440-1746.2012.07241.x · 3.63 Impact Factor