Comparison of Duodenal Stenting vs Transpyloric and Duodenal Stenting for Malignant Obstruction
Comparison of Duodenal Stenting vs Transpyloric and Duodenal Stenting for Malignant Obstruction
Malignant duodenal obstruction in patients not fit for surgery is treated by placing enteral stents during endoscopy. These patients may also have poor gastric motility. Hence bridging the pyloric opening with the stent along with the duodenal obstruction may deliver better symptomatic improvement. Both approaches are commonly clinically practiced but no formal comparative studies have been done to compare which one is better.
Enteral self-expanding metal stents are routinely used to palliate malignant gastric outlet obstruction (pancreas cancer, duodenal cancer, gastric cancer and metastasis) in patients not fit for surgical bypass. The technical success in placing these stents approaches ~100% and many of these procedures can be performed in an outpatient setting. However the functional success (patient's ability to eat) is much lower than the technical success. One of the major reasons for this discrepancy is these patients are on narcotics, which are known to be associated with poor gastric motility. At the discretion of the gastroenterologist, FDA approved enteral stents are placed either completely within the duodenum bridging the obstruction or placed across the pyloric opening besides bridging the duodenal obstruction. The significance of this study is to determine if trans-pyloric extension of an intra-duodenal stent facilitates better gastric emptying compared to an intra-duodenal stent without trans-pyloric extension.
Inclusion Criteria:
1 - Confirmed diagnosis of cancer
2. Evidence of a single small bowel obstruction
3. Considered palliative (can be on narcotics, chemotherapy, and/or radiation therapy)
4. Not a surgical candidate
5. >18 years of age
6. Able to give consent
7. Eligible for endoscopy (medically fit)
8. Able to traverse past obstruction with a guidewire
Exclusion Criteria:
1 - <18 years of age
2. Unable to give consent
3. Pregnant
4. Have evidence of multiple sites of obstruction in the small bowel
5. Have evidence of duodenal obstruction secondary to gastric cancer
6. Ineligible for endoscopy (due to comorbidities or acuity of illness)
7. Unable to traverse past obstruction with a guidewire