Self-Expandable Metal Stents for the Management of Gastric Outlet Obstruction: Experience from A Tertiary-Care Facility in Pakistan

Abstract

1. Abstract 1.1. Aim Gastric outlet obstruction is commonly considered as advanced malignancies of the stomach, duodenum, pancreas, hepatobiliary, and ampullary regions. Surgical bypass and chemotherapy are the common treatment modalities for gastric obstruction. This study was done to determine the outcomes of self-expandable metal stents in patients with gastric outlet obstruction. 1.2. Methods Forty-seven symptomatic patients with gastric outlet obstruction who underwent self-expandable metal stents in Patel hospital, Karachi-Pakistan from January 2013 till January 2020 were selected for the study. Data on the relief of obstructive symptoms such as; nausea and vomiting and improvement in food intake was the primary clinical success outcome, measured by the gastric outlet obstruction score. Data were statistically analyzed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). 1.3. Results Number of 47 patients received uncovered self-expandable stent (Boston Scientific WallFlex) placements during the study period with n=22 (46.8%) single stents, while n=25 (53.2%) dual stents (enteral and biliary), with a mean ±SD age of 60.6 (±14.1) years. Fifteen (31.9%) participants showed good improvement, n=23 (48.9%) patients showed mild improvements, n=04 (8.5%) reported moderate improvement, while only n=05 (10.6%) patients showed no improvements at all after placement of the intervention. The median survival time after the intervention was 8.5 weeks (95% CI: 5.469 – 11.674) in the study population. 1.4. Conclusion The endoscopic stenting for malignant gastric outlet obstruction appears to be an effective alternative to surgical palliative bypass. 2. Introduction Gastric outlet obstruction (GOO) is a result of mechanical gastroduodenal obstruction. Moreover, the incursion of upper abdominal carcinomatosis or metastases from advanced extra-abdominal cancer may also incite GOO. GOO is primarily divided into three major categories, which are benign mechanical, malignant mechanical, and motility disorders [1]. The malignant gastric outlet obstruction (MGOO) typically distresses the areas of the distal stomach or proximal duodenum, resulting in poor prognosis due to gastric and pancreatic malignancies [2]. However, malignant infiltration by neoplasms from adjacent organs and compression by malignant regional lymphadenopathy may also contribute to an exacerbation of existing obstruction [3]. Obstruction is an advanced occurrence in GOO manifesting with nausea, vomiting, poor appetite, and an overall reduction in the quality of life of these patients adding to quality-adjusted life years (QALYs) alongside a significant burden on the healthcare resources [4, 6]. In some patients, symptoms including abdominal pain, esoph-