Brief Article
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World J Gastroenterol. Mar 7, 2012; 18(9): 938-943
Published online Mar 7, 2012. doi: 10.3748/wjg.v18.i9.938
Duodenal stenting for malignant gastric outlet obstruction: Prospective study
Eduardo Guimarães Hourneaux Moura, Flávio Coelho Ferreira, Spencer Cheng, Diogo Turiani Hourneaux Moura, Paulo Sakai, Bruno Zilberstain
Eduardo Guimarães Hourneaux Moura, Flávio Coelho Ferreira, Spencer Cheng, Diogo Turiani Hourneaux Moura, Paulo Sakai, Gastrointestinal Endoscopy Unit, University of Sao Paulo, Sao Paulo, SP 05679-065, Brazil
Bruno Zilberstain, Department of Gastroenterology, University of Sao Paulo, Sao Paulo, SP 05679-065, Brazil
Author contributions: Moura EGH and Ferreira FC contributed equally to this work; Moura EGH, Ferreira FC, Cheng S and Moura DTH designed and performed the research; Moura EGH, Ferreira FC, Zilberstain B and Sakai P analyzed the data; and Moura EGH, Ferreira FC and Cheng S wrote the paper.
Correspondence to: Eduardo Guimarães Hourneaux Moura, MD, PhD, Assistant Professor of Medicine, Director of Gastrointestinal Endoscopy Unit, University of Sao Paulo, 255 Dr. Eneas de Carvalho Aguiar, Sao Paulo, SP 05679-065, Brazil. eghm@uol.com.br
Telephone: +55-11-38877593 Fax: +55-11-38877593
Received: January 21, 2011
Revised: November 16, 2011
Accepted: December 31, 2011
Published online: March 7, 2012
Abstract

AIM: To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score (GOOS).

METHODS: A prospective, non-randomized study was performed at a tertiary center between August 2005 and April 2010. Patients were eligible if they had malignant gastric outlet obstruction (GOO) and were not candidates for surgical treatment. Medical history and patient demographics were collected at baseline. Scheduled interviews were made on the day of the procedure and 15, 30, 90 and 180 d later or unscheduled as necessary.

RESULTS: Fifteen patients (6 male, 9 female; median age 61 years) with GOO who had undergone duodenal stenting were evaluated. Ten patients had metastasis at baseline (66.6%) and 14 were unable to accept oral intake (93.33%), including 7 patients who were using a feeding tube. Laboratory data showed biliary obstruction in eight cases (53.33%); all were submitted to biliary drainage. Two patients developed obstructive symptoms due to tumor ingrowth after 30 d and another due to tumor overgrowth after 180 d. Two cases of stent migration occurred. A good response to treatment was observed, with a mean time of approximately 1 d (19 h) until toleration of a liquid diet and slightly more than 2 d for both soft solids (51 h) and a solid food/normal diet (55 h). The mean time to first failure to maintain liquid intake (GOOS ≥ 1) was 93 d. During follow-up, the mean time to first failure to maintain the previously achieved GOOS of 2-3 (solid/semi-solid food), considered technical failure, was 71 d. On the basis of oral intake a GOOS is defined: 0 for no oral intake; 1 for liquids only; 2 for soft solids only; 3 for low-residue or full diet.

CONCLUSION: Enteral stenting to alleviate gastroduodenal malignant obstruction improves quality of life in patients with limited life expectancy, which can be evaluated by using a GOO scoring system.

Keywords: Enteral stenting, Gastric outlet obstruction scoring system, Gastroduodenal malignancy, Self-expandable metal stent