Background: The current management of malignant gastric outlet obstruction (GOO) in unresectable patients include surgical diversion or placement of an enteral stent. Aims: We analyzed the long term results including predictive factors of outcomes, and complications associated with enteral stents with focus on their management.
Methods: Between 1997 and 2007, 46 patients with malignant GOO underwent palliative placement of a uncoverered self expandable metal stent (SEMS). Patients were captured in a database and followed until complication or death. Patency, management of complications and long term survival were analyzed.
Results: 46 patients had a mean survival of 146 days ± 225 days and a mean SEMS patency rate of 110 days ± 211 days. Life table analysis demonstrates SEMS patency rates of 80%, 33%, 18%, and 8% at 1, 3, 6 and 12 months respectively. 13 (28%) patients presented with recurrent obstructive symptoms and included 2 SEMS migration, 2 early occlusion (within 1 week), 1 fracture, 4 malignant recurrence of obstruction (>2 weeks) and 4 failed to have symptomatic improvement despite confirmed endoscopic patency. Interventions included endoscopic balloon dilation (3), argon plasma coagulation (1), and/or SEMS replacement (3)while 6 had PEG-J placed. Two patients underwent surgical bypass for continued symptoms. One patient with duodenal perforation underwent successful surgical repair and one developed an aortoenteric fistula managed with a combination of endovascular stenting and surgery.
Conclusions: SEMS effectively palliate gastric outlet obstructions that result from upper GI malignancies, especially in the short term. Their benefit has to be weighted against potential complications or malfunctions. With gastroenterologists placing those devices more frequently, it is crucial for the surgeons to be aware of their potential complications and the best management options.