Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Meth...Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.展开更多
文摘Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.
