Peroral intubation of a self-expanding metal stent is usually difficult in patients with unresectable malignant gastric outlet obstruction.
This is because current delivery systems are not long enough and cannot easily pass the angulated gastroduodenal structure.
J. H. Kim and colleagues from medical universities in Suwon and Incheon, South Korea, have conducted a study to assess the efficacy of a newly developed long delivery system, specifically designed for palliation of unresectable malignant gastric outlet obstruction.
In a prospective study, the researchers identified 29 patients with unresectable malignant gastric outlet obstruction, caused by gastric cancer (26 patients), pancreatic head cancer (2 patients), or duodenal cancer (1 patient).
In each patient peroral intubation of a self-expanding nickel-titanium coil stent was attempted, using a lengthened delivery system of 150 cm, under endoscopic and fluoroscopic guidance.
| The self-expanding coil stent has a lengthened delivery system of 150 cm.|
The researchers were able to successfully manage 26 of the 29 patients, representing just under 90% of the study population, without immediate major complications.
In one patient in whom peroral intubation failed, percutaneous intubation of the coil stent via percutaneous endoscopic gastrostomy was done.
After insertion of the coil stent, food ingestion with symptomatic improvement with regard to vomiting was achieved in 26 of 27 patients (96%), including the patient with percutaneous stent insertion.
During the follow-up period, dysphagia and overall patient health, as judged by Karnofsky scores, also significantly improved.
Stent migration occurred in two patients, and tumor ingrowth was identified in a further two patients; re-intervention was carried out successfully in two instances.
The mean survival time was 124 days (range 34-310 days) in the 22 subjects who had no need for re-intervention during follow-up. Among these was a patient who experienced stent occlusion by food material. This was easily corrected with endoscopic flushing.
The research team concluded that peroral intubation of the self-expanding coil stent, using a long delivery system, is a safe and effective palliative technique. It also significantly improved quality of life of patients.