Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction Journal Article


Authors: Mendelsohn, R. B.; Gerdes, H.; Markowitz, A. J.; Dimaio, C. J.; Schattner, M. A.
Article Title: Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction
Abstract: Background: Endoscopically inserted self-expandable metal stents (SEMSs) are used to palliate malignant gastric outlet obstruction (GOO). Peritoneal disease is considered a relative contraindication to SEMS placement given the risk of multifocal obstruction. Objective: To evaluate the success of SEMSs placed in patients with GOO with carcinomatosis. Design: Retrospective review of patients who underwent SEMS placement for malignant GOO. Setting: Large, urban cancer center. Patients: A total of 215 patients who were scheduled for SEMS placement for GOO. Interventions: SEMS placement. Main Outcome Measurements: Technical success, clinical success, early and late SEMS failure, and complications. Results: Technical success was achieved in 192 of 201 patients (95.5%). Of the 9 patients who did not achieve technical success, 6 had carcinomatosis. Among the 116 patients (60%) with carcinomatosis, clinical success was achieved 94 of them (81%). Of these 94 patients, 17 (18%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Among the 76 patients (40%) without carcinomatosis, clinical success was achieved in 64 of them (84%). Of these 64 patients, 17 (27%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Complication rates were similar for both groups. Limitations: This was a retrospective review with experienced clinicians selecting patients whom they thought would benefit from SEMS placement. Conclusions: This is the first study to evaluate the effect of carcinomatosis on the technical and clinical success of SEMSs in the palliation of malignant GOO. We found clinical outcomes comparable to those without peritoneal disease. Carcinomatosis should not be considered a contraindication to SEMS placement in selected patients with malignant GOO. © 2011 American Society for Gastrointestinal Endoscopy.
Keywords: adult; treatment outcome; aged; middle aged; treatment failure; retrospective studies; major clinical study; ascites; palliative care; hypotension; pancreatitis; reoperation; stent; carcinomatous peritonitis; treatment contraindication; equipment failure; digestive system neoplasms; carcinomatosis; stents; digestive tract endoscopy; gastric outlet obstruction; stomach obstruction; endoscopy, gastrointestinal; stomach perforation; self expandable metal stent
Journal Title: Gastrointestinal Endoscopy
Volume: 73
Issue: 6
ISSN: 0016-5107
Publisher: Mosby Elsevier  
Date Published: 2011-06-01
Start Page: 1135
End Page: 1140
Language: English
DOI: 10.1016/j.gie.2011.01.042
PROVIDER: scopus
PUBMED: 21470604
DOI/URL:
Notes: --- - "Export Date: 3 October 2011" - "CODEN: GAENB" - "Source: Scopus"
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MSK Authors
  1. Christopher Dimaio
    17 Dimaio
  2. Hans Gerdes
    127 Gerdes
  3. Arnold J Markowitz
    109 Markowitz
  4. Mark Schattner
    102 Schattner