Palliative surgical intervention for malignant
duodenal obstruction is often associated with a significant morbidity. Endoscopic enteral stenting offers a suitable alternative, that is safe, effective, and less invasive. This study reports our experience with the use of self-expanding
metal stents in the palliation of malignant gastric
duodenal obstruction.
METHODS: A retrospective review of all patients who underwent duodenal stenting from November 1998 to February 2001 was performed. All the patients had symptomatic gastric outlet and
duodenal obstruction with
nausea,
vomiting, and decreased oral intake. All of them underwent enteral stenting with self-expandable
metal Wallstents 20 or 22 mm in diameter and 6 or 9 cm long.
RESULTS: For this study, 33 patients (19 men and 14 women) with a mean age of 62 years (range, 37-81 years) were identified, 32 of whom had successful duodenal
stent placement (6 were performed as
outpatient surgery). The
malignancies were pancreatic 18 (54%), gastric 4 (12%), duodenal 3 (9%), metastatic 6 (18%), and
cholangiocarcinoma 2 (6%) disorders. The site of obstruction was pyloric (n = 5; 15%), pyloroduodenal (n = 3; 9%), duodenal bulb (n = 11; 33%), second portion of duodenum (n = 9; 27%), second and third portion of duodenum (n = 3; 9%), C-loop (n = 1; 3%), and anastomotic (n = 1; 3%). A total of 29 patients (91%) had good clinical outcomes, with relief of obstructive symptoms, Two of three patients with no symptomatic relief underwent
gastrojejunostomy. One patient refused further treatment. No immediate
stent-related complications were noted. During the follow-up period, 20 patients died (none as a result
stent-related causes) due to progression of
cancer. Median survival was 102 days. Four patients had recurrent obstruction (2
tumor ingrowths, 1 overgrowth, and 1 distally migrated
stent) at a mean interval of 82 days. All four had successful restenting without complications.
CONCLUSION: