Technical success of endoscopic stenting for malignant gastric outlet obstruction

Authors

Keywords:

malignant gastric outlet obstruction, self-expanding metal stents, endoscopic stenting, duodenal stent, gastric stent

Abstract

Background: Palliation of irresectable malignant gastric outlet obstruction (GOO) using self-expanding metal stents (SEMS) is gaining popularity with high technical success rates. The aim of this study was to review and compare GOO stenting for malignancy with other series.

Methods: A retrospective review of all patients undergoing pyloroduodenal stenting for malignant GOO at Groote Schuur Hospital, 1 March 2018–31 August 2021, evaluating demographics, technical success, pathology, and stent-related complications was done.

Results: One hundred and fourteen patients, of which 38.6% were female, were included, with gastric malignancies (74.6%) being the most frequent underlying pathology. Median age was 64 years (IQR 53–70 years), with 48.2% having at least one comorbidity. The majority (96 patients; 85.7%) required only one stent. In total, 132 stent insertion attempts were undertaken. Three technical failures were experienced (one incorrect stent placement and two failed insertions), equating to a 97.4% technical success rate. Four immediate complications occurred (3.1%): two related to sedation, one incorrect stent placement and an oesophagogastric junction perforation with procedural death. Fifteen delayed complications occurred: 13 tumour in-growth blockages, one stent fracture and one case of poor radial stent expansion. Stent blockages occurred at a median of 107 days (IQR 80–275 days). Salvage stenting was 100% successful in 14 cases requiring re-stenting.

Conclusion: Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.

Author Biographies

D Tait, University of Cape Town

Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

MF Scriba, University of Cape Town

Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

C Robinson, University of Cape Town

Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

EG Jonas, University of Cape Town

Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

GE Chinnery, University of Cape Town

Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

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Published

2023-12-14

Issue

Section

Surgical Oncology