Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction

A retrospective multicentre study

Jorge M. Canena, Ana C. Lagos, Inês N. Marques, Sara D. Patrocínio, Miguel G. Tomé, Manuel A. Liberato, Carlos M. Romão, António P. Coutinho, Pedro M. Veiga, Beatriz C. Neves, Hélder D. Além, José A. Gonçalves

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives. Methods: This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency. Results: Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033). Conclusion: Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.

Original languageEnglish
Pages (from-to)747-755
Number of pages9
JournalEuropean Journal of Gastroenterology and Hepatology
Volume24
Issue number7
DOIs
Publication statusPublished - Jul 2012

Fingerprint

Multicenter Studies
Stents
Retrospective Studies
Gastric Outlet Obstruction
Small Intestine
Eating
Duodenal Obstruction
Survival
Multivariate Analysis
Confidence Intervals

Keywords

  • endoscopic palliation
  • enteral stenting
  • gastric outlet obstruction
  • gastric outlet obstruction scoring system
  • self-expanding metal stent

Cite this

Canena, Jorge M. ; Lagos, Ana C. ; Marques, Inês N. ; Patrocínio, Sara D. ; Tomé, Miguel G. ; Liberato, Manuel A. ; Romão, Carlos M. ; Coutinho, António P. ; Veiga, Pedro M. ; Neves, Beatriz C. ; Além, Hélder D. ; Gonçalves, José A. / Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction : A retrospective multicentre study. In: European Journal of Gastroenterology and Hepatology. 2012 ; Vol. 24, No. 7. pp. 747-755.
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title = "Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction: A retrospective multicentre study",
abstract = "Objectives: Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives. Methods: This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency. Results: Technical and clinical success was achieved in 100 and 97.2{\%} of the patients, respectively. A total of 71/74 patients (95.9{\%}) continued oral intake for the rest of their lives and 58/74 patients (78.4{\%}) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5{\%}). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9{\%}. Malignant stent reobstruction was observed in 7/74 patients (9.5{\%}). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95{\%} confidence interval=1.14-24.45; P=0.033). Conclusion: Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.",
keywords = "endoscopic palliation, enteral stenting, gastric outlet obstruction, gastric outlet obstruction scoring system, self-expanding metal stent",
author = "Canena, {Jorge M.} and Lagos, {Ana C.} and Marques, {In{\^e}s N.} and Patroc{\'i}nio, {Sara D.} and Tom{\'e}, {Miguel G.} and Liberato, {Manuel A.} and Rom{\~a}o, {Carlos M.} and Coutinho, {Ant{\'o}nio P.} and Veiga, {Pedro M.} and Neves, {Beatriz C.} and Al{\'e}m, {H{\'e}lder D.} and Gon{\cc}alves, {Jos{\'e} A.}",
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Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction : A retrospective multicentre study. / Canena, Jorge M.; Lagos, Ana C.; Marques, Inês N.; Patrocínio, Sara D.; Tomé, Miguel G.; Liberato, Manuel A.; Romão, Carlos M.; Coutinho, António P.; Veiga, Pedro M.; Neves, Beatriz C.; Além, Hélder D.; Gonçalves, José A.

In: European Journal of Gastroenterology and Hepatology, Vol. 24, No. 7, 07.2012, p. 747-755.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oral intake throughout the patients' lives after palliative metallic stent placement for malignant gastroduodenal obstruction

T2 - A retrospective multicentre study

AU - Canena, Jorge M.

AU - Lagos, Ana C.

AU - Marques, Inês N.

AU - Patrocínio, Sara D.

AU - Tomé, Miguel G.

AU - Liberato, Manuel A.

AU - Romão, Carlos M.

AU - Coutinho, António P.

AU - Veiga, Pedro M.

AU - Neves, Beatriz C.

AU - Além, Hélder D.

AU - Gonçalves, José A.

PY - 2012/7

Y1 - 2012/7

N2 - Objectives: Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives. Methods: This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency. Results: Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033). Conclusion: Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.

AB - Objectives: Patients with inoperable malignant gastric outlet obstruction (GOO) have been managed with self-expandable metal stents to improve oral intake. Recent studies have shown conflicting results on the capacity of self-expandable metal stents to restore food intake in the long term. This study evaluated the clinical effectiveness of enteral stent placement for GOO throughout the patients' lives. Methods: This was a multicentre, retrospective study with a long-term follow-up of 74 patients who underwent enteral stenting for symptomatic GOO. Data were collected to analyse improvements in oral intake for the patients' entire lives as assessed by the GOO scoring system (GOOSS), technical success, stent patency, complications, the need for reintervention, survival and the prognostic factors associated with stent patency. Results: Technical and clinical success was achieved in 100 and 97.2% of the patients, respectively. A total of 71/74 patients (95.9%) continued oral intake for the rest of their lives and 58/74 patients (78.4%) needed no further intervention until death. Solid food intake (GOOSS 2-3) continued until death in 47/74 patients (63.5%). The GOOSS score improved (P<0.001) during the follow-up compared with the baseline. The median survival and the mean stent patency were 8 and 76.6 weeks, respectively. The complication rate was 18.9%. Malignant stent reobstruction was observed in 7/74 patients (9.5%). A Cox multivariate analysis showed that duodenal location of the obstruction was the only independent factor associated with stent patency (hazard ratio=5.28; 95% confidence interval=1.14-24.45; P=0.033). Conclusion: Enteral stenting in patients with unresectable GOO is safe and clinically effective. Ninety-five per cent of patients are able to resume oral intake for the rest of their lives, and the great majority remain free from further intervention. In approximately two-thirds of patients, solid food intake continues until death.

KW - endoscopic palliation

KW - enteral stenting

KW - gastric outlet obstruction

KW - gastric outlet obstruction scoring system

KW - self-expanding metal stent

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U2 - 10.1097/MEG.0b013e328353d9d3

DO - 10.1097/MEG.0b013e328353d9d3

M3 - Article

VL - 24

SP - 747

EP - 755

JO - European Journal Of Gastroenterology & Hepatology

JF - European Journal Of Gastroenterology & Hepatology

SN - 0954-691X

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ER -