Malignant gastric outlet obstruction managed by endoscopic stenting: a prospective single-centre study

Area of Science:

• Gastroenterology
• Oncology
• Interventional Endoscopy

Background:

• Advanced upper gastrointestinal cancers often present late, leading to malignant gastric outlet obstruction.
• This complication significantly impacts patients through weight loss and anorexia, limiting life expectancy.
• Surgical bypass is a traditional palliative option, but endoscopic stenting is emerging as a potentially superior alternative.

Purpose of the Study:

• To evaluate the safety and efficacy of endoscopic stenting as a primary palliative strategy for malignant gastric outlet obstruction.
• To compare the clinical outcomes of endoscopic stenting with surgical interventions in terms of patient well-being and cost-effectiveness.

Main Methods:

• A prospective study enrolled 45 consecutive patients with gastric outlet obstruction due to advanced upper GI-tract malignancy.
• Patients were offered endoscopic stenting using self-expanding nitinol stents.
• The gastric outlet obstruction score system (GOOSS) was used to assess oral intake before and after stenting.

Main Results:

• Successful stent deployment was achieved in 91% of patients (41 out of 45).
• The mean GOOSS significantly improved from 0.39 to 2.29 post-stenting (p<0.0001), with 63% of patients showing at least a one-point improvement.
• The procedure demonstrated a zero rate of procedure-related mortality, with low rates of complications such as perforation (4%) and stent migration (7%).

Conclusions:

• Palliative endoscopic stenting is a safe, feasible, and effective treatment for advanced malignant upper GI-tract tumors causing gastric outlet obstruction.
• It offers a viable alternative to surgical bypass, characterized by a short hospital stay and rapid improvement in food intake.
• The procedure leads to significant palliation of symptoms, enhancing the quality of life for patients with limited life expectancy.