Gastric and duodenal stenting – pro

Patient had an apporpriate and timely workup and management. A CT scan on 4/116 revealed duodenal abstruction. EGD and a dudodenal stent was placed on 4/17. NGT was stopped 4/18 and clear liquids started. I do find a delay in advancing diet; soft diet was started only on the 20th, an unnecessary delay of 1 day. He was discharged on 4/21.

In well patients, surgery via gastroenterostomy is the traditional method for palliation of Gastric outlet obstruction (GOO) or duodenal obstruction. With unresectable cancer, the risks associated with surgical bypass and the possibility of postoperative delayed gastric emptying can outweigh the benefits. Conservative measures, such as nasoenteric tube feeding and venting gastrostomy, do little to relieve obstructive symptoms and do not allow patients the pleasure of oral food intake. Some patients develop recurrent malignant obstruction after palliative bypass. Endoscopic placement of SEMS can be a useful nonsurgical alternative for palliation of GOO. The first reported use of SEMS for malignant GOO was in the early 1990s. Nonrandomized prospective studies and retrospective studies have also compared surgical outcomes with endoscopic stent outcomes in GOO. In one study, the median time to oral fluid intake was up to 1 day after stenting, 4 days after laparoscopy, and 6 days after open surgery. In-hospital costs were lower for patients who underwent endoscopic stenting.

Mosler P et al. (2005) Palliation of gastric outlet obstruction and proximal small bowel obstruction with self-expandable metal stents: a single center series. J Clin Gastroenterol 39: 124-128
Fiori E et al. (2004) Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs endoscopic stenting. A randomized prospective trial. Anticancer Res 24: 269-271
Johnsson E et al. (2004) Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 28: 812-817

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