Background: The endoscopic placement of a self-expandable metal stent (SEMS), an alternative to surgical bypass for the palliation of malignant gastric outlet obstruction (GOO), is commonly performed using a forward-viewing endoscope with a wide therapeutic channel; however, due to limited availability, most Indian centers use a side-viewing duodenoscope. We studied the feasibility and outcome of SEMS placement using side- and forward-viewing endoscopes.
Method: Data of patients undergoing SEMS placement using side- and forward-viewing endoscopes with a therapeutic channel for the palliation of malignant GOO presenting during a 5-year period were analyzed retrospectively. Follow-up data were obtained from records and telephonic interviews, and technical and clinical success, complications, and survival were evaluated.
Results: Of 114 patients (age 56.5 ± 11.6 years, 59 [52%] female), 90 (79%) and 24 (21%) underwent SEMS placement using side- and forward-viewing endoscopes, respectively. Technical (89, 98.9% vs. 24, 100%, P = ns) and clinical success (84, 93.3% vs. 23, 95.8%, P = ns) and complication rate (3, 3.3% vs. 0, P = ns) between side- and forward-viewing endoscopes were comparable. However, SEMS could be placed in a shorter time using a forward- rather than side-viewing endoscope (21 min [inter-quartile range 19.5-35] vs. 34 min [25-45], P = < 0.001). SEMS could be deployed successfully with a forward-viewing endoscope in two patients in whom an initial attempt using side-viewing endoscope failed. Gastric outlet obstruction scoring system (GOOSS) improved following stent placement (median 0, range 0-2 vs. 2, 0-3, P = 0.0001). The survival of patients undergoing SEMS placement using side- and forward-viewing endoscopes was comparable.
Conclusion: Although side- and forward-viewing endoscopes are equally effective for antroduodenal SEMS placement, the procedure can be performed faster using the latter.
Keywords: enteral nutrition; gallbladder cancer; gastric cancer; gastric outlet obstruction; vomiting.