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Background. Self-expanding metal stents (SEMS) are commonly used in the palliative treatment of malignant gastrointestinal (GI) obstructions with favorable short-term outcome. Data on long-term outcome are scarce, however. Aim. To evaluate long-term outcome after palliative stent treatment of malignant GI obstruction. Method. Between October 2006 and April 2008, nine Norwegian hospitals included patients treated with SEMS for malignant esophageal, gastroduodenal, biliary, and colonic obstructions. Patients were followed for at least 6 months with respect to stent patency, reinterventions, and readmissions. Results. Stent placement was technically successful in 229 of 231 (99%) and clinically successful after 1 week in 220 of 229 (96%) patients. Long-term follow-up was available for 219 patients. Of those, 72 (33%) needed reinterventions. Stent occlusions or migrations (92%) were the most common reasons. Esophageal stents required reinterventions most frequently (41%), and had a significantly ( p = 0.02) shorter patency (median 152 days) compared to other locations (gastroduodenal, 256 days; colon, 276 days; biliary, 460 days). Eighty percent of reinterventions were repeated endoscopic procedures that successfully restored patency. Readmissions were required for 156 (72%) patients. Progression of the underlying cancer was the most common reason, whereas 24% were readmitted due to stent complications. Conclusions. Long-term outcome after palliative treatment with SEMS for malignant GI and biliary obstruction shows that 70% had a patent stent until death, and that most reobstructions could be solved endoscopically. Hospital readmissions were mainly related to progression of the underlying cancer disease. [ABSTRACT FROM AUTHOR]

Background: Endoscopic sphincterotomy (EPT) is well established as a treatment of bile duct stones, often performed to reduce the frequency of complications. We wanted to evaluate the complication rates after preventive cholecystectomy compared with expectative follow up., Material and Methods: In this retrospective study we have registered the outcome for 63 patients treated with cholecystectomy and 298 patients followed up expectatively. Allocation to the groups was based on clinical evaluation without randomization, hence the groups are not similar, a fact which should be taken into consideration when results are evaluated. For both groups we have registered events due to biliary complications., Results: The patients submitted to cholecystectomy were somewhat younger with higher comorbidity than the non-operated patients. In the expectative group, 27% had one or more late complications as opposed to 6.3% in the cholecystectomy group. There was no relative difference in mortality., Interpretation: The study confirms that prophylactic cholecystectomy may actually contribute to a lower complication rate and is an option for treatment in low-risk patients. Prophylactic cholecystectomy cannot, however, be recommended as a routine procedure. The study is based on clinically selected patient groups and results must be interpreted with care.