Yasuki Hori1, Itaru Naitoh2, Kazuki Hayashi1, Katsuyuki Miyabe1, Michihiro Yoshida1, Yasuaki Fujita1, Makoto Natsume1, Naruomi Jinno1, Akihisa Kato1, Takahiro Nakazawa3, Shuya Shimizu3, Atsuyuki Hirano4, Fumihiro Okumura5, Tomoaki Ando6, Hitoshi Sano7, Hiroki Takada8, Shozo Togawa9, Takashi Joh1. 1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, 467-8601, Japan. 2. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, 467-8601, Japan. inaito@med.nagoya-cu.ac.jp. 3. Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan. 4. Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan. 5. Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 6. Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan. 7. Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan. 8. Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan. 9. Department of Gastroenterology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
Abstract
PURPOSE: Self-expandable metallic stents (SEMSs) may be used to effectively palliate malignant gastric outlet obstructions (GOOs), but their utility and efficacy in patients under best supportive care (BSC) have not been explored. METHOD: In this multicenter retrospective study, we reviewed data on patients under BSC who underwent endoscopic SEMS placement to treat malignant GOO without chemotherapy. We evaluated the safety and efficacy of the procedure. RESULTS: We enrolled a total of 208 patients. SEMS placement was technically successful in 207 (99.5%) and clinically successful in 164 (78.8%). The mean procedure time was 25.6 ± 2.8 min. Stent dysfunction later developed in 30 (14.4%) patients, of whom 90% (27/30) underwent reintervention. The procedure-related mortality rate was 1.44%; all deaths were due to pneumonia. Subgroup analysis by Karnofsky performance status (KPS) revealed that neither technical success, stent dysfunction, reintervention rate, procedure-related pneumonia or death, nor death within 14 days differed between patients with good and poor KPS. However, the clinical success rate and the median survival time were significantly lower and shorter, respectively, in those with poor KPS (p < 0.001). CONCLUSIONS: Duodenal SEMS placement is an effective palliative treatment for malignant GOO in BSC patients. Although the GOO score did not dramatically improve in patients with poor KPS, the procedure was safe and palliatively feasible. Procedure-related pneumonia was fatal; thus, it is essential to proceed with great caution. TRIAL REGISTRATION: Clinical trial registration number: UMIN000028367.
PURPOSE: Self-expandable metallic stents (SEMSs) may be used to effectively palliate malignant gastric outlet obstructions (GOOs), but their utility and efficacy in patients under best supportive care (BSC) have not been explored. METHOD: In this multicenter retrospective study, we reviewed data on patients under BSC who underwent endoscopic SEMS placement to treat malignant GOO without chemotherapy. We evaluated the safety and efficacy of the procedure. RESULTS: We enrolled a total of 208 patients. SEMS placement was technically successful in 207 (99.5%) and clinically successful in 164 (78.8%). The mean procedure time was 25.6 ± 2.8 min. Stent dysfunction later developed in 30 (14.4%) patients, of whom 90% (27/30) underwent reintervention. The procedure-related mortality rate was 1.44%; all deaths were due to pneumonia. Subgroup analysis by Karnofsky performance status (KPS) revealed that neither technical success, stent dysfunction, reintervention rate, procedure-related pneumonia or death, nor death within 14 days differed between patients with good and poor KPS. However, the clinical success rate and the median survival time were significantly lower and shorter, respectively, in those with poor KPS (p < 0.001). CONCLUSIONS: Duodenal SEMS placement is an effective palliative treatment for malignant GOO in BSC patients. Although the GOO score did not dramatically improve in patients with poor KPS, the procedure was safe and palliatively feasible. Procedure-related pneumonia was fatal; thus, it is essential to proceed with great caution. TRIAL REGISTRATION: Clinical trial registration number: UMIN000028367.
Entities:
Keywords:
Best supportive care; Malignant gastric outlet obstruction; Self-expandable metal stent
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