Carcinomatosis is not a contraindication to enteral stenting in selected patients with malignant gastric outlet obstruction

Abstract

Background: Endoscopically inserted self-expandable metal stents (SEMSs) are used to palliate malignant gastric outlet obstruction (GOO). Peritoneal disease is considered a relative contraindication to SEMS placement given the risk of multifocal obstruction.

Objective: To evaluate the success of SEMSs placed in patients with GOO with carcinomatosis.

Design: Retrospective review of patients who underwent SEMS placement for malignant GOO.

Setting: Large, urban cancer center.

Patients: A total of 215 patients who were scheduled for SEMS placement for GOO.

Interventions: SEMS placement.

Main outcome measurements: Technical success, clinical success, early and late SEMS failure, and complications.

Results: Technical success was achieved in 192 of 201 patients (95.5%). Of the 9 patients who did not achieve technical success, 6 had carcinomatosis. Among the 116 patients (60%) with carcinomatosis, clinical success was achieved 94 of them (81%). Of these 94 patients, 17 (18%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Among the 76 patients (40%) without carcinomatosis, clinical success was achieved in 64 of them (84%). Of these 64 patients, 17 (27%) required reinterventions: 4 for early SEMS failure and 13 for late SEMS failure. Complication rates were similar for both groups.

Limitations: This was a retrospective review with experienced clinicians selecting patients whom they thought would benefit from SEMS placement.

Conclusions: This is the first study to evaluate the effect of carcinomatosis on the technical and clinical success of SEMSs in the palliation of malignant GOO. We found clinical outcomes comparable to those without peritoneal disease. Carcinomatosis should not be considered a contraindication to SEMS placement in selected patients with malignant GOO.