Long-term outcome of palliative treatment with self-expanding metal stents for malignant obstructions of the GI tract

Abstract

Background. Self-expanding metal stents (SEMS) are commonly used in the palliative treatment of malignant gastrointestinal (GI) obstructions with favorable short-term outcome. Data on long-term outcome are scarce, however. Aim. To evaluate long-term outcome after palliative stent treatment of malignant GI obstruction. Method. Between October 2006 and April 2008, nine Norwegian hospitals included patients treated with SEMS for malignant esophageal, gastroduodenal, biliary, and colonic obstructions. Patients were followed for at least 6 months with respect to stent patency, reinterventions, and readmissions. Results. Stent placement was technically successful in 229 of 231 (99%) and clinically successful after 1 week in 220 of 229 (96%) patients. Long-term follow-up was available for 219 patients. Of those, 72 (33%) needed reinterventions. Stent occlusions or migrations (92%) were the most common reasons. Esophageal stents required reinterventions most frequently (41%), and had a significantly (p = 0.02) shorter patency (median 152 days) compared to other locations (gastroduodenal, 256 days; colon, 276 days; biliary, 460 days). Eighty percent of reinterventions were repeated endoscopic procedures that successfully restored patency. Readmissions were required for 156 (72%) patients. Progression of the underlying cancer was the most common reason, whereas 24% were readmitted due to stent complications. Conclusions. Long-term outcome after palliative treatment with SEMS for malignant GI and biliary obstruction shows that 70% had a patent stent until death, and that most reobstructions could be solved endoscopically. Hospital readmissions were mainly related to progression of the underlying cancer disease.

Key Words::

• endoscopy-interventional
• oncology-clinical

Acknowledgments/Contributors

List of participating hospitals, departments. Oslo University Hospital, Ullevål, Dept. of Gastroenterology, Oslo, Norway. Stavanger University Hospital, Dept. of Surgery, Stavanger, Norway. Østfold Hospital Trust Fredrikstad, Dept. of Internal Medicine, Fredrikstad, Norway. Vestre Viken Hospital Trust Drammen, Dept. of Surgery, Drammen, Norway. Innlandet Hospital Trust Gjøvik, Dept. of Internal Medicine, Gjøvik, Norway. Oslo University Hospital, Aker, Dept. of Surgery, Oslo, Norway. Innlandet Hospital Trust Lillehammer, Dept. of Internal Medicine, Lillehammer, Norway. Nord- Trøndelag Hospital Trust Levanger, Dept. of Surgery, Levanger, Norway. Oslo University Hospital, AHUS, Dept. of Surgery, Oslo, Norway.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.