A Retrospective Review of the Technical Success of Endoscopic Stenting for Malignant Gastric Outlet Obstruction

Tait,  Déan

A Retrospective Review of the Technical Success of Endoscopic Stenting for Malignant Gastric Outlet Obstruction

Master Thesis

2022

Abstract

Introduction: Palliation of patients with advanced and irresectable malignancies causing gastric outlet obstruction (GOO) with the endoscopic placement of a self-expanding metal stent (SEMS) has become standard. Internationally, technical success rates are high. This study reviewed endoscopic stent placement for malignant GOO compared to other international high-volume endoscopy units, looking into local success rates, pathology, and patient demographics. Methods: A retrospective review of patients presenting to the Groote Schuur Hospital Upper Gastrointestinal Unit with irresectable malignant GOO between 1 March 2018 and 31 August 2021 was performed, evaluating demographics, technical success, pathology, and immediate and late stent complications. Results: One hundred and fourteen patients, 44 (38.6%) female and 70 (61.4%) male, were referred for palliative stenting of malignant GOO; distal obstructive gastric cancer (74.6%) and obstructing pancreatic malignancies (14.9%) being the two most frequent indications. Median age was 63.5years (IQR: 53.25-70) with 48.2% having at least one comorbidity and 48.3% performance scores of 3 or 4. The majority (96; 85.7%) required only one stent, 15 patients (13.4%) had a second stent placed, and one patient required four stents. In total, 132 stent insertion attempts were undertaken. With primary placement, three technical failures were experienced. One stent was initially incorrectly placed but immediately correctly repositioned, while two failed insertions were referred for surgical gastrojejunostomy, equating to a technical success rate of 97.4%.Four immediate stent insertion related complications occurred (3.1%), two related to sedation, one stent placed too distally requiring repositioning and an oesophagogastric junction perforation with procedural death. Fifteen late-stent complications occurred with thirteen stent blockages due to tumour in-growth (10%), one stent fracture and one stent with poor radial expansion. The stent blockages occurred between 3 to 548 days after placement (median 107 days, IQR: 80 – 275 days). Salvage stenting was 100% successful in the 14 cases with late stent complications that required re-stenting. Conclusion: Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.

Keywords

Surgery

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