Primary palliative treatment of malignant gastric outlet obstruction with a selfexpanding metal stent

Background and objective: A high operative mortality, diffuse local tumor g rowth and abnormal wound healing are significant risk factors in the pallia tive surgical treatment of gastric outlet obstruction caused by a malignant tumor. This study was undertaken to evaluate the use of selfexpanding meta l stents as an alternative. Patients and methods: Over a period of 33 months, nine previously unoperate d patients (three women, six men; mean age 71,4 [66-76] years) with gastric outlet obstruction by a malignant tumor underwent endoscopic implantation of an uncoated self-expanding nitinol Ultraflex stent. The stent's length w as 7 and 10 cm, respectively, the length of the carrier catheter was 92 cm. The stent was implantated after balloon dilatation of the stenosis and mar king the distal tumor margin with lipiodol injected over a guide-wire under fluoroscopic control. Results: The implantation was successful in only two of the first five pati ents, but after modifying the method of stent release in three of the four subsequent patients. All patients reported an improved quality of life. One patient died after 10 days of the underlying malignancy. There were no com plications associated with the implantation. Conclusions: Insertion of a self-expanding metal stent can provide pallatio n in patients with inoperable gastric outlet stenosis due to malignant tumo ur. The number of successful implantations can probably be increased by opt imizing some of the devices used, for example by lengthening the carrier ca theter.