Stage IV gastric cancer with gastric outlet obstruction treated with a stent

What happened, in summary

A 76-year-old woman had Stage IV gastric cancer with para-aortic lymph-node metastasis. She first received S-1 plus oxaliplatin chemotherapy and later ramucirumab plus paclitaxel. The cancer nevertheless progressed and eventually blocked the gastric outlet, causing nausea and vomiting.

A self-expanding metal stent was placed across the obstruction. Her symptoms improved immediately, she was able to eat a regular diet again, and she was discharged. Two weeks later she was readmitted for an unrelated thoracic compression fracture. During that admission, nausea gradually returned. Four weeks after the original stent placement, imaging and endoscopy showed that the stent had fractured, with part of it migrating back into the stomach and the outlet narrowing again.

The broken piece was removed endoscopically and a second metal stent was placed through the remaining first stent. After the repeat procedure, she could again eat solid food and was discharged. Although the gastric cancer continued to progress and she died 3 months later, the stent treatment allowed her to maintain oral food intake until death.