Expandable metallic prostheses for malignant obstructions of gastric outlet and proximal small bowel,☆☆,

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Abstract

Background: Data are limited on use of expandable metal stents for treatment of malignant gastric outlet obstruction. Accordingly, we report our experience using these stents to palliate malignant obstructions of the gastric outlet, duodenum, and proximal jejunum. Methods: Eight patients with malignant strictures causing gastric obstruction underwent endoscopy with fluoroscopic guidance to delineate tumor borders and length followed by expandable metallic prosthesis placement (Wallstent, Z-Stent, Ultraflex, and Endocoil). Results: Symptoms were relieved in seven patients, five of whom had previous surgeries (Whipple, Billroth II, esophagojejunostomy, and gatrojejunostomy) for malignancy. One patient underwent surgical resection of a presumed malignant stricture containing a previously placed Wallstent after a 45-pound weight gain. Conclusions: Expandable metallic prostheses placed in patients with malignant obstruction of the gastric outlet, duodenum, or proximal jejunum, before or after surgery, effectively palliate obstructive symptoms and may also serve to improve nutrition.

Section snippets

Methods and Materials

We reviewed the records of eight patients with malignant strictures of the gastric outlet and proximal small bowel treated with expandable prostheses between 1991 to 1997. Data collected included patient demographics, diagnosis, indication for stent placement (with type and location of stent), and overall outcome. Outcome criteria included survival data, need for reintervention, and the ability to take oral nutrition.

Prostheses placed included the Endocoil (Instent Inc., Eden Prairie, Minn.),

Results

Patients were divided into those who had undergone previous surgery for obstruction and those patients with nonoperative, widespread disease. All presented with signs of gastric outlet and proximal small bowel obstruction. A subset of these patients were previously reported in a series that included colorectal stents.36

Five patients who had previously undergone surgical procedures developed strictures related to local recurrence at or near the surgical anastomoses (Billroth II, Whipple,

Discussion

We used a variety of expandable metallic prostheses to palliate patients with malignant gastric outlet and proximal small bowel obstruction who were at significant risk for initial or follow-up surgical decompression or who would benefit nutritionally before surgery. All stent insertions were technically successful and clinical improvement, defined as increased oral intake, was noted in seven of eight (87.5%) patients. Moreover, in the five patients who have died to date, mean survival was

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    From the Department of Radiology, Section of Gastroenterology, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.

    ☆☆

    Reprint requests: Adam W. Nevitt, MD, Department of Radiology, virginia Mason Medical Center, 1100 Ninth Ave., PO Box 900 (C5-XR), Seattle, WA 98111.

    37/69/87539

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