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03.05.2018 | Original Article | Ausgabe 10/2018

Supportive Care in Cancer 10/2018

The utility and efficacy of self-expandable metal stents for treating malignant gastric outlet obstructions in patients under best supportive care

Zeitschrift:
Supportive Care in Cancer > Ausgabe 10/2018
Autoren:
Yasuki Hori, Itaru Naitoh, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuaki Fujita, Makoto Natsume, Naruomi Jinno, Akihisa Kato, Takahiro Nakazawa, Shuya Shimizu, Atsuyuki Hirano, Fumihiro Okumura, Tomoaki Ando, Hitoshi Sano, Hiroki Takada, Shozo Togawa, Takashi Joh

Abstract

Purpose

Self-expandable metallic stents (SEMSs) may be used to effectively palliate malignant gastric outlet obstructions (GOOs), but their utility and efficacy in patients under best supportive care (BSC) have not been explored.

Method

In this multicenter retrospective study, we reviewed data on patients under BSC who underwent endoscopic SEMS placement to treat malignant GOO without chemotherapy. We evaluated the safety and efficacy of the procedure.

Results

We enrolled a total of 208 patients. SEMS placement was technically successful in 207 (99.5%) and clinically successful in 164 (78.8%). The mean procedure time was 25.6 ± 2.8 min. Stent dysfunction later developed in 30 (14.4%) patients, of whom 90% (27/30) underwent reintervention. The procedure-related mortality rate was 1.44%; all deaths were due to pneumonia. Subgroup analysis by Karnofsky performance status (KPS) revealed that neither technical success, stent dysfunction, reintervention rate, procedure-related pneumonia or death, nor death within 14 days differed between patients with good and poor KPS. However, the clinical success rate and the median survival time were significantly lower and shorter, respectively, in those with poor KPS (p < 0.001).

Conclusions

Duodenal SEMS placement is an effective palliative treatment for malignant GOO in BSC patients. Although the GOO score did not dramatically improve in patients with poor KPS, the procedure was safe and palliatively feasible. Procedure-related pneumonia was fatal; thus, it is essential to proceed with great caution.

Trial registration

Clinical trial registration number: UMIN000028367

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