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Erschienen in: Supportive Care in Cancer 10/2018

03.05.2018 | Original Article

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

verfasst von: 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

Erschienen in: Supportive Care in Cancer | Ausgabe 10/2018

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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
Literatur
1.
Zurück zum Zitat Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492CrossRefPubMed Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492CrossRefPubMed
2.
Zurück zum Zitat Yoon WJ, Ryu JK, Yang KY, Paik WH, Lee JK, Woo SM, Park JK, Kim YT, Yoon YB (2009) A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 70:284–289CrossRefPubMed Yoon WJ, Ryu JK, Yang KY, Paik WH, Lee JK, Woo SM, Park JK, Kim YT, Yoon YB (2009) A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 70:284–289CrossRefPubMed
3.
Zurück zum Zitat Ly J, O'Grady G, Mittal A et al (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297CrossRefPubMed Ly J, O'Grady G, Mittal A et al (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297CrossRefPubMed
4.
Zurück zum Zitat Tringali A, Didden P, Repici A, Spaander M, Bourke MJ, Williams SJ, Spicak J, Drastich P, Mutignani M, Perri V, Roy A, Johnston K, Costamagna G (2014) Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 79:66–75CrossRefPubMed Tringali A, Didden P, Repici A, Spaander M, Bourke MJ, Williams SJ, Spicak J, Drastich P, Mutignani M, Perri V, Roy A, Johnston K, Costamagna G (2014) Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc 79:66–75CrossRefPubMed
5.
Zurück zum Zitat Miyabe K, Hayashi K, Nakazawa T, Sano H, Yamada T, Takada H, Naitoh I, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Hori Y, Kato A, Ohara H, Joh T (2015) Safety and benefits of self-expandable metallic stents with chemotherapy for malignant gastric outlet obstruction. Dig Endosc 27:572–581CrossRefPubMed Miyabe K, Hayashi K, Nakazawa T, Sano H, Yamada T, Takada H, Naitoh I, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Hori Y, Kato A, Ohara H, Joh T (2015) Safety and benefits of self-expandable metallic stents with chemotherapy for malignant gastric outlet obstruction. Dig Endosc 27:572–581CrossRefPubMed
6.
Zurück zum Zitat Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221CrossRefPubMed Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221CrossRefPubMed
7.
Zurück zum Zitat Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825CrossRefPubMed Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825CrossRefPubMed
8.
Zurück zum Zitat Murad AM, Santiago FF, Petroianu A, Rocha PRS, Rodrigues MAG, Rausch M (1993) Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 72:37–41CrossRefPubMed Murad AM, Santiago FF, Petroianu A, Rocha PRS, Rodrigues MAG, Rausch M (1993) Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 72:37–41CrossRefPubMed
9.
Zurück zum Zitat Glimelius B, Hoffman K, Haglund U, Nyrén O, Sjödén PO (1994) Initial or delayed chemotherapy with best supportive care in advanced gastric cancer. Ann Oncol 5:189–190CrossRefPubMed Glimelius B, Hoffman K, Haglund U, Nyrén O, Sjödén PO (1994) Initial or delayed chemotherapy with best supportive care in advanced gastric cancer. Ann Oncol 5:189–190CrossRefPubMed
10.
Zurück zum Zitat Hori Y, Miyabe K, Yoshida M, Nakazawa T, Hayashi K, Naitoh I, Shimizu S, Kondo H, Nishi Y, Umemura S, Kato A, Ohara H, Inagaki H, Joh T (2015) Impact of TP53 codon 72 and MDM2 SNP 309 polymorphisms in pancreatic ductal adenocarcinoma. PLoS One 10:e0118829CrossRefPubMedPubMedCentral Hori Y, Miyabe K, Yoshida M, Nakazawa T, Hayashi K, Naitoh I, Shimizu S, Kondo H, Nishi Y, Umemura S, Kato A, Ohara H, Inagaki H, Joh T (2015) Impact of TP53 codon 72 and MDM2 SNP 309 polymorphisms in pancreatic ductal adenocarcinoma. PLoS One 10:e0118829CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78CrossRefPubMed Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78CrossRefPubMed
12.
Zurück zum Zitat Gaidos JK, Draganov PV (2009) Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 15:4365–4371CrossRefPubMedPubMedCentral Gaidos JK, Draganov PV (2009) Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 15:4365–4371CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, de Moura EGH, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 44:37–43CrossRefPubMed Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, de Moura EGH, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 44:37–43CrossRefPubMed
14.
Zurück zum Zitat Mendelsohn RB, Gerdes H, Markowitz AJ, DiMaio CJ, Schattner MA (2011) Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction. Gastrointest Endosc 73:1135–1140CrossRefPubMed Mendelsohn RB, Gerdes H, Markowitz AJ, DiMaio CJ, Schattner MA (2011) Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction. Gastrointest Endosc 73:1135–1140CrossRefPubMed
15.
Zurück zum Zitat Lee EY, Bourke MJ, Williams SJ et al (2011) Severity of initial stent angulation predicts reintervention after successful palliative enteral stenting for malignant luminal obstruction. J Gastroenterol Hepatol 26:484–491CrossRefPubMed Lee EY, Bourke MJ, Williams SJ et al (2011) Severity of initial stent angulation predicts reintervention after successful palliative enteral stenting for malignant luminal obstruction. J Gastroenterol Hepatol 26:484–491CrossRefPubMed
16.
Zurück zum Zitat van Hooft JE, van Montfoort ML, Jeurnink SM, Bruno M, Dijkgraaf M, Siersema P, Fockens P (2011) Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy 43:671–675CrossRefPubMed van Hooft JE, van Montfoort ML, Jeurnink SM, Bruno M, Dijkgraaf M, Siersema P, Fockens P (2011) Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy 43:671–675CrossRefPubMed
17.
Zurück zum Zitat Hori Y, Hayashi K, Yoshida M, Naitoh I, Nakazawa T, Miyabe K, Shimizu S, Kondo H, Nishi Y, Umemura S, Kato A, Ohara H, Joh T (2016) New concept of traction force applied to biliary self-expandable metallic stents. Endoscopy 48:472–476CrossRefPubMed Hori Y, Hayashi K, Yoshida M, Naitoh I, Nakazawa T, Miyabe K, Shimizu S, Kondo H, Nishi Y, Umemura S, Kato A, Ohara H, Joh T (2016) New concept of traction force applied to biliary self-expandable metallic stents. Endoscopy 48:472–476CrossRefPubMed
18.
Zurück zum Zitat Hori Y, Hayashi K, Yoshida M, Naitoh I, Ban T, Miyabe K, Kondo H, Nishi Y, Umemura S, Fujita Y, Natsume M, Kato A, Ohara H, Joh T (2017) Novel characteristics of traction force in biliary self-expandable metallic stents. Dig Endosc 29:347–352CrossRefPubMed Hori Y, Hayashi K, Yoshida M, Naitoh I, Ban T, Miyabe K, Kondo H, Nishi Y, Umemura S, Fujita Y, Natsume M, Kato A, Ohara H, Joh T (2017) Novel characteristics of traction force in biliary self-expandable metallic stents. Dig Endosc 29:347–352CrossRefPubMed
19.
Zurück zum Zitat Fiori E, Lamazza A, Volpino P, Burza A, Paparelli C, Cavallaro G, Schillaci A, Cangemi V (2004) Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 24:269–271PubMed Fiori E, Lamazza A, Volpino P, Burza A, Paparelli C, Cavallaro G, Schillaci A, Cangemi V (2004) Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 24:269–271PubMed
20.
Zurück zum Zitat Hori Y, Naitoh I, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, Yoshida M, Yamashita H, Umemura S, Ban T, Okumura F, Sano H, Takada H, Joh T (2014) Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients. J Gastroenterol Hepatol 29:648–652CrossRefPubMed Hori Y, Naitoh I, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, Yoshida M, Yamashita H, Umemura S, Ban T, Okumura F, Sano H, Takada H, Joh T (2014) Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients. J Gastroenterol Hepatol 29:648–652CrossRefPubMed
21.
Zurück zum Zitat Hori Y, Naitoh I, Hayashi K et al Predictors of outcomes in patients undergoing covered and uncovered self-expandable metal stent placement for malignant gastric outlet obstruction: a multicenter study. Gastrointest Endosc 2017 85:340–348 e341 Hori Y, Naitoh I, Hayashi K et al Predictors of outcomes in patients undergoing covered and uncovered self-expandable metal stent placement for malignant gastric outlet obstruction: a multicenter study. Gastrointest Endosc 2017 85:340–348 e341
22.
Zurück zum Zitat Hori Y, Naitoh I, Hayashi K, Ban T, Natsume M, Okumura F, Nakazawa T, Takada H, Hirano A, Jinno N, Togawa S, Ando T, Kataoka H, Joh T (2017) Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents. Surg Endosc 31:4165–4173. https://doi.org/10.1007/s00464-017-5471-7: CrossRefPubMed Hori Y, Naitoh I, Hayashi K, Ban T, Natsume M, Okumura F, Nakazawa T, Takada H, Hirano A, Jinno N, Togawa S, Ando T, Kataoka H, Joh T (2017) Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents. Surg Endosc 31:4165–4173. https://​doi.​org/​10.​1007/​s00464-017-5471-7:​ CrossRefPubMed
23.
Zurück zum Zitat Hori Y, Naitoh I, Ban T, Narita K, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Kato A, Yamada T, Ando T, Joh T (2015) Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol 30:1246–1251CrossRefPubMed Hori Y, Naitoh I, Ban T, Narita K, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, Nishi Y, Yoshida M, Umemura S, Kato A, Yamada T, Ando T, Joh T (2015) Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol 30:1246–1251CrossRefPubMed
Metadaten
Titel
The utility and efficacy of self-expandable metal stents for treating malignant gastric outlet obstructions in patients under best supportive care
verfasst von
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
Publikationsdatum
03.05.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Supportive Care in Cancer / Ausgabe 10/2018
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4221-2

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