Treatment for malignant gastric outlet obstruction

Drs Park and ParkChan Hyuk Park, MD and Jun Chul Park, MD from the Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology at Yonsei University College of Medicine in Seoul, Republic of Korea discuss their article “Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy.”

In our study, we compared clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer.

We had come to know clinical outcomes of self-expandable metal stent (SEMS) placement depends on patient’s ascites status through our previous study.¹ And we found that carcinomatosis with ascites was a significant predictive factor for poor clinical success of SEMS placement. Therefore, we aimed to compare the clinical outcomes of SEMS placement and palliative gastrojejunostomy (GJJ) according to carcinomatosis and ascites status.

We performed subgroup analyses for patients with good performance status (ECOG 1 or 2) according to the carcinomatosis and ascites status. In a subgroup of patients who had neither carcinomatosis nor ascites, patency and overall survival durations did not differ between the SEMS placement and palliative GJJ groups. SEMS placement may function at its best in patients without carcinomatosis and ascites. In addition, use of SEMS placement shortened the hospital stay and facilitated early resumption of oral intake compared to that of palliative GJJ. We recommend SEMS placement as a primary therapeutic option for patients with neither carcinomatosis nor ascites.

Next, in a subgroup of patients who had carcinomatosis but not ascites, the patency duration of palliative GJJ was longer than that of SEMS placement. Overall survival, however, did not differ between the two groups. In this case, the use of palliative GJJ may increase quality of life due to its longer patency compared to that of SEMS placement. It is doubtful, however, that palliative GJJ should be recommended as a primary therapeutic option, because the difference in overall survival between the two treatment modalities was insignificant. In this subgroup, we believe that clinicians can choose the treatment modality for each individual patient.

Finally, in a subgroup of patients with carcinomatosis and ascites, palliative GJJ had better patency and overall survival durations than SEMS placement. It implied that patency duration of SEMS placement was more affected by ascites than that of palliative GJJ. In addition, the shorter patency duration in patients who underwent SEMS placement compared to palliative GJJ could have a bad influence on their nutritional status. Poor nutritional support might also result in poor overall survival. Therefore, we recommend the use of palliative GJJ in this subgroup of patients prior to SEMS placement.

Table 3

Palliative treatment modalities can be chosen according to the carcinomatosis and ascites status. Our recommendations based on the results of the study, however, should be supported by large randomized-controlled trial.

Find the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

¹Jeon HH, Park CH, Park JC, et al. Carcinomatosis matters: clinical outcomes and prognostic factors for clinical success of stent placement in malignant gastric outlet obstruction. Surgical endoscopy 2014;28:988-95.

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