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01-10-2018 | Original Article

The utility and efficacy of self-expandable metal stents for treating malignant gastric outlet obstructions in patients under best supportive care

Authors: Yasuki Hori, Itaru Naitoh, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuaki Fujita, Makoto Natsume, Naruomi Jinno, Akihisa Kato, Takahiro Nakazawa, Shuya Shimizu, Atsuyuki Hirano, Fumihiro Okumura, Tomoaki Ando, Hitoshi Sano, Hiroki Takada, Shozo Togawa, Takashi Joh

Published in: Supportive Care in Cancer | Issue 10/2018

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

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Title: The utility and efficacy of self-expandable metal stents for treating malignant gastric outlet obstructions in patients under best supportive care
Authors: Yasuki Hori
Itaru Naitoh
Kazuki Hayashi
Katsuyuki Miyabe
Michihiro Yoshida
Yasuaki Fujita
Makoto Natsume
Naruomi Jinno
Akihisa Kato
Takahiro Nakazawa
Shuya Shimizu
Atsuyuki Hirano
Fumihiro Okumura
Tomoaki Ando
Hitoshi Sano
Hiroki Takada
Shozo Togawa
Takashi Joh
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 10/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4221-2

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Purpose

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