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Published in: Surgical Endoscopy 10/2012

01-10-2012

Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival

Authors: Lene Larssen, Truls Hauge, Asle W. Medhus

Published in: Surgical Endoscopy | Issue 10/2012

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Abstract

Background

Advanced pancreatic cancer and other malignancies located proximal to the small bowel might cause gastric outlet obstruction (GOO) resulting in nausea, vomiting, dehydration, and malnutrition. Self-expandable metal stents (SEMS) to a large extent have replaced surgical treatment, with gastro-entero-anastomosis as palliative treatment for GOO. The aim of the present study was to evaluate the effect of duodenal stenting on the rate of gastric emptying, symptoms, and survival.

Methods

Patients with endoscopically verified malignant obstruction of the proximal duodenum were included. Gastric emptying rate was measured prior to and within 1 week after stent placement using a meal containing 13C-octanoic acid as a marker. Symptoms related to GOO were assessed by the patients before and 2 weeks after stent treatment and during the gastric emptying tests. All patients were followed up until death.

Results

In the patients included (n = 17), all studied variables of gastric emptying improved significantly following treatment, and a reduction in self-reported obstructive symptoms was observed. There was no correlation between survival and the rate of gastric emptying before or after, or the change in the rate of emptying.

Conclusion

The present study demonstrated that treatment with SEMS results in improved gastric emptying in most patients with GOO and a corresponding reduction in self-reported obstruction symptoms. However, survival and emptying were not related. The present findings provide further evidence that treatment with stents is an effective palliative treatment in patients with GOO.
Literature
1.
go back to reference Aa PM, Pedersen L, Groenvold M (2007) Does the agreement of patient and physician assessments of health related quality of life in palliative care depend on patient characteristics? Palliat Med 21:289–294CrossRef Aa PM, Pedersen L, Groenvold M (2007) Does the agreement of patient and physician assessments of health related quality of life in palliative care depend on patient characteristics? Palliat Med 21:289–294CrossRef
2.
go back to reference Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRef Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRef
3.
go back to reference Bar-Natan M, Larson GM, Stephens G, Massey T (1996) Delayed gastric emptying after gastric surgery. Am J Surg 172:24–28PubMedCrossRef Bar-Natan M, Larson GM, Stephens G, Massey T (1996) Delayed gastric emptying after gastric surgery. Am J Surg 172:24–28PubMedCrossRef
4.
go back to reference Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, Moore J, Koller M, Turhal NS, Stuart R, Van CE, D’haese S, Coens C (2004) Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer 40:2260–2268PubMedCrossRef Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, Moore J, Koller M, Turhal NS, Stuart R, Van CE, D’haese S, Coens C (2004) Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer 40:2260–2268PubMedCrossRef
5.
go back to reference Choi MG, Camilleri M, Burton DD, Zinsmeister AR, Forstrom LA, Nair KS (1998) Reproducibility and simplification of 13C-octanoic acid breath test for gastric emptying of solids. Am J Gastroenterol 93:92–98PubMedCrossRef Choi MG, Camilleri M, Burton DD, Zinsmeister AR, Forstrom LA, Nair KS (1998) Reproducibility and simplification of 13C-octanoic acid breath test for gastric emptying of solids. Am J Gastroenterol 93:92–98PubMedCrossRef
6.
go back to reference Christakis NA, Lamont EB (2000) Extent and determinants of error in physicians’ prognoses in terminally ill patients: prospective cohort study. West J Med 172:310–313PubMedCrossRef Christakis NA, Lamont EB (2000) Extent and determinants of error in physicians’ prognoses in terminally ill patients: prospective cohort study. West J Med 172:310–313PubMedCrossRef
7.
go back to reference Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, De Moura EG, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: An international prospective multicentre registry. Dig Liver Dis 44(1):37–43PubMedCrossRef Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A, Johnsson E, De Moura EG, Cheng S, Ponchon T, Bittinger M, Messmann H, Neuhaus H, Schumacher B, Laugier R, Saarnio J, Ariqueta FI (2012) Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: An international prospective multicentre registry. Dig Liver Dis 44(1):37–43PubMedCrossRef
8.
go back to reference Doberneck RC, Berndt GA (1987) Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg 122:827–829PubMedCrossRef Doberneck RC, Berndt GA (1987) Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg 122:827–829PubMedCrossRef
9.
go back to reference Dormann A, Meisner S, Verin N, Wenk LA (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550PubMedCrossRef Dormann A, Meisner S, Verin N, Wenk LA (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550PubMedCrossRef
10.
go back to reference Easson AM, Lee KF, Brasel K, Krouse RS (2003) Clinical research for surgeons in palliative care: challenges and opportunities. J Am Coll Surg 196:141–151PubMedCrossRef Easson AM, Lee KF, Brasel K, Krouse RS (2003) Clinical research for surgeons in palliative care: challenges and opportunities. J Am Coll Surg 196:141–151PubMedCrossRef
11.
go back to reference Fayers PM, Aaronson NK, Bjordal K, Grønvold M, Curran D, Bottomley A, The EORTC QLQ-C30 Scoring Manual (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels Fayers PM, Aaronson NK, Bjordal K, Grønvold M, Curran D, Bottomley A, The EORTC QLQ-C30 Scoring Manual (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels
12.
go back to reference Ferte C, Penel N, Bonneterre J, Adenis A (2010) Individual life expectancy estimation using validated prognostic scores for patients with cancer of unknown primary. Oncology 78:87–93PubMedCrossRef Ferte C, Penel N, Bonneterre J, Adenis A (2010) Individual life expectancy estimation using validated prognostic scores for patients with cancer of unknown primary. Oncology 78:87–93PubMedCrossRef
13.
go back to reference Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G (1993) Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 104:1640–1647PubMed Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G (1993) Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 104:1640–1647PubMed
14.
go back to reference Holmebakk T, Solbakken A, Mala T, Nesbakken A (2011) Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy. Eur J Surg Oncol 37:571–575PubMedCrossRef Holmebakk T, Solbakken A, Mala T, Nesbakken A (2011) Clinical prediction of survival by surgeons for patients with incurable abdominal malignancy. Eur J Surg Oncol 37:571–575PubMedCrossRef
15.
go back to reference Jeurnink SM, Steyerberg EW, van Hooft JE, van Eijck CH, Schwartz MP, Vleggaar FP, Kuipers EJ, Siersema PD (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499PubMedCrossRef Jeurnink SM, Steyerberg EW, van Hooft JE, van Eijck CH, Schwartz MP, Vleggaar FP, Kuipers EJ, Siersema PD (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499PubMedCrossRef
16.
go back to reference Jeurnink SM, Steyerberg EW, Vleggaar FP, van Eijck CH, van Hooft JE, Schwartz MP, Kuipers EJ, Siersema PD (2011) Predictors of survival in patients with malignant gastric outlet obstruction: a patient-oriented decision approach for palliative treatment. Dig Liver Dis 43:548–552PubMedCrossRef Jeurnink SM, Steyerberg EW, Vleggaar FP, van Eijck CH, van Hooft JE, Schwartz MP, Kuipers EJ, Siersema PD (2011) Predictors of survival in patients with malignant gastric outlet obstruction: a patient-oriented decision approach for palliative treatment. Dig Liver Dis 43:548–552PubMedCrossRef
17.
go back to reference Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD (2007) Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 7:18PubMedCrossRef Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD (2007) Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 7:18PubMedCrossRef
18.
go back to reference Keranen I, Udd M, Lepisto A, Halttunen J, Kylanpaa L (2010) Outcome for self-expandable metal stents in malignant gastroduodenal obstruction: single-center experience with 104 patients. Surg Endosc 24:891–896CrossRef Keranen I, Udd M, Lepisto A, Halttunen J, Kylanpaa L (2010) Outcome for self-expandable metal stents in malignant gastroduodenal obstruction: single-center experience with 104 patients. Surg Endosc 24:891–896CrossRef
19.
go back to reference Kim JH, Song HY, Shin JH, Choi E, Kim TW, Jung HY, Lee GH, Lee SK, Kim MH, Ryu MH, Kang YK, Kim BS, Yook JH (2007) Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66:256–264PubMedCrossRef Kim JH, Song HY, Shin JH, Choi E, Kim TW, Jung HY, Lee GH, Lee SK, Kim MH, Ryu MH, Kang YK, Kim BS, Yook JH (2007) Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66:256–264PubMedCrossRef
20.
go back to reference Larssen L, Medhus AW, Hauge T (2009) Treatment of malignant gastric outlet obstruction with stents: an evaluation of the reported variables for clinical outcome. BMC Gastroenterol 9:45PubMedCrossRef Larssen L, Medhus AW, Hauge T (2009) Treatment of malignant gastric outlet obstruction with stents: an evaluation of the reported variables for clinical outcome. BMC Gastroenterol 9:45PubMedCrossRef
21.
go back to reference Larssen L, Medhus AW, Hjermstad MJ, Korner H, Glomsaker T, Soberg T, Gleditsch D, Hovde O, Nesbakken A, Tholfsen JK, Skreden K, Hauge T (2011) Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study. Surg Endosc 25:3162–3169PubMedCrossRef Larssen L, Medhus AW, Hjermstad MJ, Korner H, Glomsaker T, Soberg T, Gleditsch D, Hovde O, Nesbakken A, Tholfsen JK, Skreden K, Hauge T (2011) Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study. Surg Endosc 25:3162–3169PubMedCrossRef
22.
go back to reference Lawaetz O, Dige-Petersen H (1989) Gastric emptying of liquid meals: validation of the gamma camera technique. Nucl Med Commun 10:353–364PubMedCrossRef Lawaetz O, Dige-Petersen H (1989) Gastric emptying of liquid meals: validation of the gamma camera technique. Nucl Med Commun 10:353–364PubMedCrossRef
23.
go back to reference Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, Pitt HA, Yeo CJ (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:322–328PubMedCrossRef Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, Pitt HA, Yeo CJ (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:322–328PubMedCrossRef
24.
go back to reference Ly J, O’Grady G, Mittal A, Plank L, Windsor JA (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297PubMedCrossRef Ly J, O’Grady G, Mittal A, Plank L, Windsor JA (2010) A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 24:290–297PubMedCrossRef
25.
go back to reference Maetani I, Ukita T, Tada T, Ikeda M, Seike M, Terada H, Kohda E (2008) Gastric emptying in patients with palliative stenting for malignant gastric outlet obstruction. Hepatogastroenterology 55:298–302PubMed Maetani I, Ukita T, Tada T, Ikeda M, Seike M, Terada H, Kohda E (2008) Gastric emptying in patients with palliative stenting for malignant gastric outlet obstruction. Hepatogastroenterology 55:298–302PubMed
26.
go back to reference Maire F, Hammel P, Ponsot P, Aubert A, O’Toole D, Hentic O, Levy P, Ruszniewski P (2006) Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 101:735–742PubMedCrossRef Maire F, Hammel P, Ponsot P, Aubert A, O’Toole D, Hentic O, Levy P, Ruszniewski P (2006) Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 101:735–742PubMedCrossRef
27.
go back to reference Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De CF, Hanks G, Kaasa S (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the steering committee of the European association for palliative care. J Clin Oncol 23:6240–6248PubMedCrossRef Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De CF, Hanks G, Kaasa S (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations: a study by the steering committee of the European association for palliative care. J Clin Oncol 23:6240–6248PubMedCrossRef
28.
go back to reference Medhus AW, Bjornland K, Emblem R, Husebye E (2007) Liquid and solid gastric emptying in adults treated for Hirschsprung’s disease during early childhood. Scand J Gastroenterol 42:34–40PubMedCrossRef Medhus AW, Bjornland K, Emblem R, Husebye E (2007) Liquid and solid gastric emptying in adults treated for Hirschsprung’s disease during early childhood. Scand J Gastroenterol 42:34–40PubMedCrossRef
29.
go back to reference Perri F, Bellini M, Portincasa P, Parodi A, Bonazzi P, Marzio L, Galeazzi F, Usai P, Citrino A, Usai-Satta P (2010) (13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): Toward standardization for testing gastric emptying of solids. D. Dig Liver Dis 42:549–553PubMedCrossRef Perri F, Bellini M, Portincasa P, Parodi A, Bonazzi P, Marzio L, Galeazzi F, Usai P, Citrino A, Usai-Satta P (2010) (13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): Toward standardization for testing gastric emptying of solids. D. Dig Liver Dis 42:549–553PubMedCrossRef
30.
go back to reference Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, Petrella V, Barni S, Zecca E, Scarpi E, Labianca R, Amadori D, Luporini G (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian multicenter and study group on palliative care. J Pain Symptom Manage 17:231–239PubMedCrossRef Pirovano M, Maltoni M, Nanni O, Marinari M, Indelli M, Zaninetta G, Petrella V, Barni S, Zecca E, Scarpi E, Labianca R, Amadori D, Luporini G (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian multicenter and study group on palliative care. J Pain Symptom Manage 17:231–239PubMedCrossRef
31.
go back to reference Shaw JM, Bornman PC, Krige JE, Stupart DA, Panieri E (2010) Self-expanding metal stents as an alternative to surgical bypass for malignant gastric outlet obstruction. Br J Surg 97:872–876PubMedCrossRef Shaw JM, Bornman PC, Krige JE, Stupart DA, Panieri E (2010) Self-expanding metal stents as an alternative to surgical bypass for malignant gastric outlet obstruction. Br J Surg 97:872–876PubMedCrossRef
32.
go back to reference Sonn GA, Sadetsky N, Presti JC, Litwin MS (2009) Differing perceptions of quality of life in patients with prostate cancer and their doctors. J Urol 182:2296–2302PubMedCrossRef Sonn GA, Sadetsky N, Presti JC, Litwin MS (2009) Differing perceptions of quality of life in patients with prostate cancer and their doctors. J Urol 182:2296–2302PubMedCrossRef
33.
go back to reference Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, Freemantle N (2008) Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer 99:883–893PubMedCrossRef Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, Freemantle N (2008) Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer 99:883–893PubMedCrossRef
34.
go back to reference Tothill P, McLoughlin GP, Heading RC (1978) Techniques and errors in scintigraphic measurements of gastric emptying. J Nucl Med 19:256–261PubMed Tothill P, McLoughlin GP, Heading RC (1978) Techniques and errors in scintigraphic measurements of gastric emptying. J Nucl Med 19:256–261PubMed
35.
go back to reference van Hooft JE, Uitdehaag MJ, Bruno MJ, Timmer R, Siersema PD, Dijkgraaf MG, Fockens P (2009) Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 69:1059–1066PubMedCrossRef van Hooft JE, Uitdehaag MJ, Bruno MJ, Timmer R, Siersema PD, Dijkgraaf MG, Fockens P (2009) Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 69:1059–1066PubMedCrossRef
36.
go back to reference Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768PubMedCrossRef Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768PubMedCrossRef
Metadata
Title
Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival
Authors
Lene Larssen
Truls Hauge
Asle W. Medhus
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2291-7

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