Treatment of malignant gastric outlet obstruction with metallic stents: assessment of whether gastrointestinal position alters efficacy.

OBJECTIVES: Gastric outlet obstruction (GOO) is a late complication of advanced gastric, pancreatic, and duodenal cancer. Palliative treatment of the obstruction is the main aim of therapy for these patients. Self-expandable metal stents are used for treating GOO. From our experience, the placement of the stent across the pylorus is easier and makes the curve of stent better than when the stent is placed within the duodenal area. The purposes of this study were to assess the efficacy of stents placed in either the duodenal area or across the pyloric valve in relieving GOO symptoms and to evaluate whether the location of the stent affects treatment outcomes. MATERIALS AND METHODS: This was a retrospective single-site study of 44 patients with malignant GOO. Expanding metal stents were placed either across the pyloric valve (n = 22; group A) or in the duodenum area (n = 22; group B). Improvement in oral intake was monitored using the Gastric Outlet Obstruction Scoring System (GOOSS). The end of the study was death of the last enrolled patient or 6 months after enrollment of the last patient, or whatever came first. RESULTS: Stent implantation similarly improved the patients' tolerance for food intake from baseline for both groups A and B (median [interquartile range]; 2 [2-3] and 2 [2-3], respectively). Patients in group B who received adjunctive chemotherapy had greater improvement in GOOSS and survival than patients in group B who did not have chemotherapy or any group A patients (P < 0.05). Stent patency was not affected by stent position or chemotherapy. CONCLUSION: Palliative treatment of GOO with placement of an expandable metal stent improved the tolerability of food intake. The location of stent across the pyloric valve or within the duodenum did not affect the efficacy of the procedure or stent patency.

The role of age in predicting the outcome of caustic ingestion in adults: a retrospective analysis.

BACKGROUND: Although the outcomes of caustic ingestion differ between children and adults, it is unclear whether such outcomes differ among adults as a function of their age. This retrospective study was performed to ascertain whether the clinical outcomes of caustic ingestion differ significantly between elderly and non-elderly adults. METHODS: Medical records of patients hospitalized for caustic ingestion between June 1999 and July 2009 were reviewed retrospectively. Three hundred eighty nine patients between the ages of 17 and 107 years were divided into two groups: non-elderly (< 65 years) and elderly (≥ 65 years). Mucosal damage was graded using esophagogastroduodenoscopy (EGD). Parameters examined in this study included gender, intent of ingestion, substance ingested, systemic and gastrointestinal complications, psychological and systemic comorbidities, severity of mucosal injury, and time to expiration. RESULTS: The incidence of psychological comorbidities was higher for the non-elderly group. By contrast, the incidence of systemic comorbidities, the grade of severity of mucosal damage, and the incidence of systemic complications were higher for the elderly group. The percentages of ICU admissions and deaths in the ICU were higher and the cumulative survival rate was lower for the elderly group. Elderly subjects, those with systemic complications had the greatest mortality risk due to caustic ingestion. CONCLUSIONS: Caustic ingestion by subjects ≥65 years of age is associated with poorer clinical outcomes as compared to subjects < 65 years of age; elderly subjects with systemic complications have the poorest clinical outcomes. The severity of gastrointestinal tract injury appears to have no impact on the survival of elderly subjects.