Many uncontrolled case series have reported effective palliation of malignant gastric outlet obstruction in the antrum, proximal small bowel, and gastro-enteral anastomoses by endoscopic SEMS placement.
Only the WALLSTENT® Enteral (Boston Scienti?c) is approved for treatment of malignant gastroduodenal obstruction. Technical success rates are generally > 90%, and 60% to 80% of patients are able to eat at least soft mechanical diets.
Through the scope deployment is possible.
When placing duodenal stents, one must consider the patient’s risk of biliary obstruction, particularly in the setting of pancreatic cancer. After duodenal stent placement, access to the ampulla for endoscopic biliary stent placement is difficult, if not impossible. Therefore, prophylactic placement of a biliary stent prior to duodenal stent placement should be considered if there is a possibility of covering the ampulla. Once a duodenal stent has been placed, percutaneous biliary drainage can be performed if biliary obstruction occurs.
Contraindications to gastroduodenal stent placement include known or suspected enteral ischemia or perforation, inability to pass a guidewire across the stricture, and the usual endoscopy contraindications.
Early gastroduodenal stent complications include bleeding and perforation. Late complications include distal stent migration, and re-obstruction caused by tumour ingrowth, reactive tissue hyperplasia, tumor overgrowth, and food impaction; these late complications can usually be managed endoscopically. Patients must receive dietary instruction to avoid food impaction after stent placement. Late perforation is uncommon, but can occur.
