[Self-expanding metal stents as palliative treatment of a malign obstruction in the distal part of the ventricle or duodenum].

INTRODUCTION

Self-expanding metal stents (SEMS) have emerged as a simple therapeutic option for the palliation of patients with non-resectable malignant gastric outlet obstruction. We present our results from a three-year period.

MATERIALS AND METHODS

Twenty-nine patients with obstruction from tumors in the pancreas (15), bile ducts (3), stomach (9) or transverse colon (2) underwent palliative stenting with a 9-cm-long, 22 mm Wallstent under general anaesthesia. Insertion of the SEMS was done under endoscopic and fluoroscopic control. Biliary stents were implanted prior to or simultaneously with the duodenal stent in eight patients. Seven were covered 6-cm-long, 10 mm Wallstents. Two patients had biliary stents implanted 12 and 262 days, respectively, after the duodenal stent by "rendezvous" technique.

RESULTS

The stent deployment was successful in all patients. There were no procedure-related complications, but one patient died of cardiac arrest 12 hours after the operation. Obstruction was relieved in all patients, and an exclusively oral diet was possible for 23 of them. Seven patients with rapid progression of the disease stayed in hospital and died 0-16 days after the procedure. The median length of stay in hospital after the procedure was 2 days (1-32 days), after which the patients stayed at home for 40 days (2-270 days). The overall median survival time was 47 days (median, 0-274 days). There were no late complications (stent migration or perforation), but two patients needed an overlapping stent due to tumor overgrowth.

DISCUSSION

Duodenal stents effectively resolve the obstructive symptoms of gastric outlet obstruction. There are few procedure-related complications, and the vast majority of patients can leave hospital and spend the short time left to them at home.