Malignant gastroduodenal? ?? Gastric outlet obstruction? separate gastroduodenal stent insertion? ???? ?? ??

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Malignant gastroduodenal? ?? Gastric outlet
obstruction? separate gastroduodenal stent
insertion? ???? ?? ??
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Introduction
? Gastric outlet obstruction

• Common clinical manifestation in benign or
  malignant
• disease of distal stomach, duodenum, and
  pancreatic
• area
• Cause
• - Gastric and pancreatic carcinoma
• - Lymphoma
• - Biliary cancer
• - Metastasis to duodenum or jejunum
• - Extrinsic compression
• Clinical Presentation
• - Nausea, Vomiting, Malnutrition
• ? Food fear

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Introduction
? Malignant Gastroduodenal obstruction

• Average survival time 34 months
• Minimally invasive but effective palliation
  method
• is required
• Surgical palliation
• - Standard palliation method
• Associated with high complication rate
• Poor general condition, Malnutrition state
• Stent insertion

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Introduction
? Gastroduodenal Stent

• 1992, Gastroduodenal stent Bare stent
• - tumor ingrowth, gronulation tissue formation
• ? Restricture
• 1999, Covered gastorguodenal stent
• - Migration(2126), biliary obstruction
• ? Self-expanding separate gastroduodenal stent

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Indications
? Gastroduodenal Stent

• Gastric, duodenal, and proximal jejunal
  malignant
• obstructions caused by non-resectable tumors
• Obstruction by recurred lesion after previous
  surgical
• anastomosis
• Benign obstruction patient with surgical risk

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Technique
? UGI - Useful for identifying length and
location of stricture ? CT - Tumor staging -
Provide valuable information concerning location
of stricture and possible additional level
of obstruction
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Case 1
? / 77 ????  No water and food ? ? ?
Malignant stomach  -
Gastroduodenal  obstruction
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Case 1
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Case 2
? / 70 ????  No water and food, vomiting
? ? ? Gastric cancer-chemotherapy
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Case 2
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Case 2
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Consideration

• we could know that patient inserted separate
• gastroduodenal stent could take ingestper oral by
  removing gastric oulet obstruction, recovered
  solwly and gained in weight.
• Recently endoscopic self-expanding stent has
  been attempted, but in gastric outlet obstruction
  disease, we could know that this procedure itself
  was not achieved because endoscopic approach was
  difficult.

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Conclusion
? Separate gastroduodenal stent placement is very
safe and effective palliation method in patients
with unresectable malignant tumors causing
gastric outlet obstruction - High technical
success rate - Less invasive - More cost
effective than surgical prcedure