Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stent...Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.展开更多
Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral in...Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral intake which can lead to dehydration, malnutrition,and poor quality of life.Endoscopic stent placement has become the primary therapeutic modality because it is safe,minimally invasive,and a cost-effective option for palliation.Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement,shorter time to resumption of an oral diet,and shorter hospital stays as compared with surgical options.Recurrence of the obstructive symptoms resulting from stent occlusion,due to tumor ingrowth or overgrowth,can be successfully treated with repeat endoscopic stent placement in the majority of the cases.Both endoscopic stenting and surgical bypass are considered palliative treatments and,to date,no improvement in survival with either modality has been demonstrated.A tailored therapeutic approach,taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist,surgeon,medical oncologist, radiation therapist,and interventional radiologist, should be considered in all cases.展开更多
AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review...AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.展开更多
In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves...In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.展开更多
文摘Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic cancer.The current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided gastroenterostomy.Most studies comparing the outcomes of the three procedures focus on technical success,clinical success and safety.Several“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of life.The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.
文摘Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral intake which can lead to dehydration, malnutrition,and poor quality of life.Endoscopic stent placement has become the primary therapeutic modality because it is safe,minimally invasive,and a cost-effective option for palliation.Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement,shorter time to resumption of an oral diet,and shorter hospital stays as compared with surgical options.Recurrence of the obstructive symptoms resulting from stent occlusion,due to tumor ingrowth or overgrowth,can be successfully treated with repeat endoscopic stent placement in the majority of the cases.Both endoscopic stenting and surgical bypass are considered palliative treatments and,to date,no improvement in survival with either modality has been demonstrated.A tailored therapeutic approach,taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist,surgeon,medical oncologist, radiation therapist,and interventional radiologist, should be considered in all cases.
文摘AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.
文摘In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.
