Palliative Treatment of Malignant Obstruction of Gastric Outlet Using an Endoscopically Placed Enteral Wallstent JESUS ESPINEL, MD, SANTIAGO VIVAS, MD, FERNANDO MUN ˜ OZ, MD, FRANCISCO JORQUERA, MD, and JOSE LUIS OLCOZ, MD Surgical gastrojejunostomy is the standard treatment for malignant gastric outlet obstruction, although it is associated with significant morbidity and mortality. The aim of this study was to evaluate the efficacy and feasibility of a newly designed expandable metal stent (Wallstent Enteral) to treat malignant gastric outlet obstruction. Six patients (five women, one man; mean age 76 years) underwent stenting. Stents 20 –22 mm in diameter and 60 –90 mm in length were deployed through a duodenoscope channel under endoscopic and fluoroscopic control, without previous stricture dilation. In all six cases the stent was adequately positioned and food intake was possible in the next 24 h. The mean time for hospital discharge was 2.5 days (1–5 days), without complications related to the procedure. Five patients died in the follow-up from progression of their cancer and one remains alive; none had recurrent obstruction. The median survival time was 9 weeks (95% CI: 3–15 weeks). In conclusion, endoscopic self-expandable stent (Wallstent Enteral) placement is safe and effective pallia- tion for malignant gastric outlet obstruction and appears to be a therapeutic alternative to surgical gastrojejunostomy. KEY WORDS: gastrointestinal endoscopy; gastric outlet obstruction; neoplasm; palliative care. Malignant gastric outlet obstruction (MGO) is caused by occlusion of lumen by intrinsic or extrinsic growth. This condition develops frequently in many situtions, such as in up to 10% of patients during the course of pancreatic cancer (1). The management of these pa- tients is sometimes difficult. Surgical gastrojejunos- tomy is the standard palliative treatment, with a high mortality rate (up to 10%) and high morbidity in very debilitated patients (2). Endoscopic treatment with periodic dilation provides temporary relief of obstruc- tion symptoms, but is associated with a high risk of perforation. Over the past few years some authors have re- ported the safety and efficacy of self-expanding metal stents used to palliate malignant gastrointestinal ob- struction in patients who were not admited for sur- gery (3). The aims of this prospective study were to evaluate the technical feasibility and efficacy of the Wallstent Enteral stent for the palliative treatment of MGO. MATERIALS AND METHODS Between July 1999 and may 2000, six patients with MGO (one man, five women, mean age 76 years) were treated with a self-expandable endoprothesis (Table 1). The etiol- ogy of MGO was pancreatic cancer in four cases, ampullary cancer in one, and cholangiocarcinoma in one. The stenosis was located in the second duodenal portion in five cases and Received Manuscript received December 14, 2000; accepted May 21, 2001. From the, Gastroenterology Unit, Hospital de Leon, Altos de Naya s/n, 24071 Leon, Spain. Address for reprint requests: Dr. Santiago Vivas, Gastroenter- ology Unit, Hospital de Leo ´n, Altos de Nava s/n, 24071 Leon, Spain. Digestive Diseases and Sciences, Vol. 46, No. 11 (November 2001), pp. 2322–2324 (© 2001) 2322 Digestive Diseases and Sciences, Vol. 46, No. 11 (November 2001) 0163-2116/01/1100-2322$19.50/0 © 2001 Plenum Publishing Corporation