Technical success of endoscopic stenting for malignant gastric outlet obstruction

Abstract

Background: Palliation of irresectable malignant gastric outlet obstruction (GOO) using self-expanding metal stents
(SEMS) is gaining popularity with high technical success rates. The aim of this study was to review and compare GOO
stenting for malignancy with other series.
Methods: A retrospective review of all patients undergoing pyloroduodenal stenting for malignant GOO at Groote
Schuur Hospital, 1 March 2018–31 August 2021, evaluating demographics, technical success, pathology, and stentrelated complications was done.
Results: One hundred and fourteen patients, of which 38.6% were female, were included, with gastric malignancies
(74.6%) being the most frequent underlying pathology. Median age was 64 years (IQR 53–70 years), with 48.2% having
at least one comorbidity. The majority (96 patients; 85.7%) required only one stent. In total, 132 stent insertion attempts
were undertaken. Three technical failures were experienced (one incorrect stent placement and two failed insertions),
equating to a 97.4% technical success rate. Four immediate complications occurred (3.1%): two related to sedation,
one incorrect stent placement and an oesophagogastric junction perforation with procedural death. Fifteen delayed
complications occurred: 13 tumour in-growth blockages, one stent fracture and one case of poor radial stent expansion.
Stent blockages occurred at a median of 107 days (IQR 80–275 days). Salvage stenting was 100% successful in 14 cases
requiring re-stenting.
Conclusion: Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par
with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting
remaining a feasible and accessible option.