This ultimately improves the quality of life in the advanced stages of cancer. Endoscopic stenting is preferable to operative gastrojejunostomy in terms of faster return to fluids and solids, and reduced morbidity for patients with a limited life span. The main drawback to operative bypass is the high incidence of delayed gastric emptying, particularly in Inhibitors,research,lifescience,medical this group of patients with symptomatic obstruction (13). Malignant gastric outlet obstruction represents often the terminal stage in pancreatic cancer. Between 5% and 25% of patients with pancreatic cancer ultimately experience malignant gastric outlet obstruction. In the present study 22 patients received gastric or duodenal stents. Uncovered

stents are used because they adhere better to the mucosa. Unfortunately common duodenal stent-related complications are a recurrence of symptoms due to stent clogging (tissue

Inhibitors,research,lifescience,medical ingrowth/overgrowth and food impaction) and stent migration. Stent dysfunction is reported in up to 25% of patients (14). Complications Inhibitors,research,lifescience,medical are ingrowth or overgrowth of tumours in 12%, bleeding in 3%, stent migration in 1.5%, and perforation in 0.5% (15). In the present study only tumour ingrowth and/or overgrowth was seen in 7 patients. These complications can be usually managed endoscopically, thereby restoring food passage (16). In a paper by Lee et al. it was reported that there was no difference in major complications between stent placement Inhibitors,research,lifescience,medical versus surgery in cases of palliation for colon cancer. The patients treated with stenting had fewer early complications which is understandable since laparotomy is not required (17). Stent placement in the colon has its complications, perforation in 9%, migration in 5%, and check details occlusion in 9% (18). Placement of a stent in the colon Inhibitors,research,lifescience,medical gives good and adequate palliation given the fact that all patients in the present study had passage of stool and were treated effectively for the obstruction. Clogging due to faecal impaction only occurred in two cases. This low percentage can be explained by the standard use of stool softeners and laxatives. No single

case of perforation occurred. This is in contradiction with the literature. Especially in cases of colon stent placement perforations are reported (19). Of course this complication is a worst case scenario because the patient was already unfit for surgery. Happily this never occurred. The possible explanation for 4��8C the perforations in the literature are the fact that stent placement was used as a bridge to surgery in patients presenting with acute bowel obstruction with pre-stenotic dilatation. In the present series all patient receiving a colon stent did not have an acute bowel obstruction. Their presentation was more chronic intermittent obstruction without pre-stenotic dilatation. In addition, the majority also suffered from malignant peritonitis.