Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2016; 22(43): 9554-9561
Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9554
Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis
Christoph Rademacher, Matthias Bechtler, Steffen Schneider, Bettina Hartmann, Johannes Striegel, Ralf Jakobs
Christoph Rademacher, Matthias Bechtler, Bettina Hartmann, Johannes Striegel, Ralf Jakobs, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, 67063 Ludwigshafen, Germany
Steffen Schneider, Department of Statistics/Stiftung IHF, Institut für Herzinfarktforschung, Bremserstraße 79, 67063 Ludwigshafen, Germany
Author contributions: Rademacher C designed and performed the research and wrote the paper; Bechtler M supervised the research and provided clinical advice; Schneider S supervised and performed the statistical analysis; Hartmann B and Striegel J provided clinical advice; Jakobs R supervised the research and the report.
Institutional review board statement: The institutional review board (Ethik-Kommission, Landesärztekammer Rheinland-Pfalz, Germany) deemed it exempt from review.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Informed consent for data sharing was not obtained but the presented data are anonymized and the risk of identification is low. No additional data are available. Questions regarding the technical procedure, statistical code and data can be addressed to the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ralf Jakobs, MD, Medical Director, Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen, Germany. jakobsr@klilu.de
Telephone: +49-621-5034100 Fax: +49-621-5034114
Received: June 17, 2016
Peer-review started: June 17, 2016
First decision: August 29, 2016
Revised: September 8, 2016
Accepted: October 10, 2016
Article in press: October 10, 2016
Published online: November 21, 2016
Processing time: 154 Days and 12.5 Hours
Abstract
AIM

To evaluate the efficacy of self-expanding metal stents (SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis (PC).

METHODS

We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.

RESULTS

In most cases, obstruction was caused by pancreatic (47%) or gastric cancer (23%). Technical success was achieved in 96.8% (60/62), clinical success in 79% (49/62) of all patients. Signs of carcinomatosis were identified in 27 patients (43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients (11.2%) and suspected by CT, MRI or ultrasound in 20 patients (32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease (66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC (median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure (median 14.5 d vs 75 d, P = 0.0003).

CONCLUSION

Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.

Keywords: Gastric outlet obstruction; Self-expanding metal stents; Peritoneal carcinomatosis; Palliation; Endoscopy

Core tip: This is a retrospective study to evaluate the efficacy of self-expanding metal stents (SEMS) for the palliation of gastric outlet obstruction in patients with peritoneal carcinomatosis (PC). Between January 2008 and April 2014 we treated 62 patients with duodenal stents for palliation of malignant gastroduodenal obstruction. In most cases, obstruction was caused by pancreatic (47%) or gastric cancer (23%). Technical success was achieved in 96.8% and clinical success in 79% of all patients. Carcinomatosis was associated with a significantly lower clinical success rate (66.7% vs 88.6%, P = 0.036). Given the limited therapeutic options and a clinical success rate of at least 66.7% we believe that SEMS are a reasonable treatment option in patients with PC.