Enteral stents for the palliation of malignant gastroduodenal obstruction
- Todd H Baron, MD
Todd H Baron, MD
- Director of Advanced Therapeutic Endoscopy
- University of North Carolina, Chapel Hill
Self-expandable metal stents are a nonsurgical alternative for the palliation of luminal gastrointestinal neoplasms, particularly in the esophagus and biliary tract. They also have a role in the palliation of obstruction in other segments of the gastrointestinal tract such as the stomach, proximal small bowel, and colon (enteral stents).
In the Western world, malignant gastric outlet obstruction occurs most commonly from obstruction of the duodenum by pancreatic cancer. Other causes at the level of the duodenum include cholangiocarcinoma and metastatic disease. Malignant gastric obstruction at the level of the stomach due to gastric cancer (primary or postsurgical recurrence) is seen more commonly in Asian countries . (See "Gastric outlet obstruction in adults".)
Gastroduodenal obstruction causes significant morbidity, including nausea, intractable vomiting, esophagitis, electrolyte imbalances, poor nutrition, and severe dehydration. In many cases, stenting can provide durable symptom relief without the morbidity associated with palliative surgery, and it may provide a better quality of life compared with other alternatives.
This topic will review the role of enteral stents for the palliation of malignant gastroduodenal obstruction. An overview of gastric outlet obstruction, as well as topics on stenting of the esophagus, biliary tract, and colon are discussed separately. (See "Gastric outlet obstruction in adults" and "Use of expandable stents in the esophagus" and "Endoscopic stenting for malignant pancreaticobiliary obstruction" and "Enteral stents for the management of malignant colorectal obstruction".)
Gastroduodenal stent placement is used to treat symptomatic patients with an unresectable malignancy or recurrence of malignancy at an anastomotic site. Patients being considered for stent placement should have a short life expectancy (less than two to six months) [2,3]. One method for estimating survival uses the World Health Organization (WHO) performance status:
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