Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents

• Published in: Gastrointestinal endoscopy Vol. 65; no. 6; pp. 782 - 787
• Main Authors: Song, Geun Am, MD, Kang, Dae Hwan, MD, Kim, Tae Oh, MD, Heo, Jeong, MD, Kim, Gwang Ha, MD, Cho, Mong, MD, Heo, Jeong Ho, MD, Kim, Jeong Yeol, MD, Lee, Jae Seung, MD, Jeoung, Yeol Jo, MD, Jeon, Tae Yong, MD, Kim, Dong Heon, MD, Sim, Mun Sup, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2007
• Subjects: Equipment Design; Equipment Safety; Female; Gastric Outlet Obstruction - etiology; Gastric Outlet Obstruction - prevention & control; Gastric Outlet Obstruction - therapy; Gastroenterology and Hepatology; Gastroscopy - methods; Humans; Male; Middle Aged; Neoplasms - complications; Retrospective Studies; Secondary Prevention; Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2006.08.030

Background Uncovered, rather than covered, metal stents are commonly used for palliation of malignant gastric outlet obstruction because of the low risk of stent migration, but tumor ingrowth risk is a major drawback. Few reports address malignant obstruction after gastric surgery. Objective Our purpose was to compare the technical feasibility and clinical outcome of using an endoscopic uncovered self-expandable metal stent (SEMS) and simultaneous use of uncovered and covered SEMS (double SEMS) in patients with recurrent malignant obstruction after gastric surgery. Design Retrospective study. Setting Tertiary care, academic medical center, from August 2000 to June 2005. Patients Twenty patients were included in the study. All patients had symptomatic obstruction with nausea, vomiting, and decreased oral intake. Intervention Ten patients received uncovered SEMS; the other 10 received double SEMS. Main Outcome Measurements To compare tumor ingrowth and stent patency between the uncovered and the double-SEMS groups. Results Technical and clinical successes were 10 of 10 and 8 of 10, respectively, in the uncovered SEMS group and 10 of 10 and 10 of 10, respectively, in the double SEMS group. Six of 10 patients (60%) with uncovered SEMS had tumor ingrowth compared with 1 of 10 patients with double SEMS, P = .057. Five of 10 patients (50%) with uncovered SEMS had very early restenosis, but no patients had early restenosis in the double SEMS group, P = .033. Stent patency was a median of 21.5 days (range, 7-217 days) in the uncovered SEMS group and 150 days (range 29-263 days) in the double SEMS group, P = .037. Survival duration was 109.5 days (range 29-280 days) and 150 days (range 29-263 days), respectively. Limitations This was a small retrospective study. Conclusion Simultaneous double stent placement seems to be technically feasible and effective for palliative treatment of recurrent malignant obstruction after gastric surgery. Double stent placement is important in preventing tumor ingrowth, especially very early restenosis, and prolongs stent patency. We suggest that this procedure be considered rather than uncovered stent alone as the primary choice for palliation of obstruction in such patients.