Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent

Background A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration. Objective To est...

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Published inGastrointestinal endoscopy Vol. 75; no. 4; pp. 757 - 763
Main Authors Isayama, Hiroyuki, MD, PhD, Sasaki, Takashi, MD, PhD, Nakai, Yousuke, MD, PhD, Togawa, Osamu, MD, PhD, Kogure, Hirofumi, MD, PhD, Sasahira, Naoki, MD, PhD, Yashima, Yoko, MD, PhD, Kawakubo, Kazumichi, MD, Ito, Yukiko, MD, Hirano, Kenji, MD, PhD, Tsujino, Takeshi, MD, PhD, Toda, Nobuo, MD, PhD, Tada, Minoru, MD, PhD, Omata, Masao, MD, PhD, Koike, Kazuhiko, MD, PhD
Format Journal Article
LanguageEnglish
Published Maryland heights, MO Mosby, Inc 01.04.2012
Elsevier
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Abstract Background A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration. Objective To estimate the efficacy and safety of the modified covered, triple-layer metal stent. Design Multicenter, prospective cohort study. Setting Three tertiary referral centers. Patients Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010. Interventions Endoscopic placement of the modified covered, triple-layer metal stent. Main Outcome Measurements The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications. Results The median GOOSS score improved significantly ( P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred. Limitations A single-arm study in tertiary-care centers. Conclusions The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (Clinical trial registration number: UMIN000004566 .)
AbstractList A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration. To estimate the efficacy and safety of the modified covered, triple-layer metal stent. Multicenter, prospective cohort study. Three tertiary referral centers. Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010. Endoscopic placement of the modified covered, triple-layer metal stent. The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications. The median GOOSS score improved significantly (P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred. A single-arm study in tertiary-care centers. The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (Clinical trial registration number: UMIN000004566.)
BACKGROUNDA high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration.OBJECTIVETo estimate the efficacy and safety of the modified covered, triple-layer metal stent.DESIGNMulticenter, prospective cohort study.SETTINGThree tertiary referral centers.PATIENTSFifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010.INTERVENTIONSEndoscopic placement of the modified covered, triple-layer metal stent.MAIN OUTCOME MEASUREMENTSThe primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications.RESULTSThe median GOOSS score improved significantly (P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred.LIMITATIONSA single-arm study in tertiary-care centers.CONCLUSIONSThe modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (CLINICAL TRIAL REGISTRATION NUMBERUMIN000004566.).
A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration. To estimate the efficacy and safety of the modified covered, triple-layer metal stent. Multicenter, prospective cohort study. Three tertiary referral centers. Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010. Endoscopic placement of the modified covered, triple-layer metal stent. The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications. The median GOOSS score improved significantly (P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred. A single-arm study in tertiary-care centers. The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. ( UMIN000004566.).
Background A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration. Objective To estimate the efficacy and safety of the modified covered, triple-layer metal stent. Design Multicenter, prospective cohort study. Setting Three tertiary referral centers. Patients Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010. Interventions Endoscopic placement of the modified covered, triple-layer metal stent. Main Outcome Measurements The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications. Results The median GOOSS score improved significantly ( P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred. Limitations A single-arm study in tertiary-care centers. Conclusions The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (Clinical trial registration number: UMIN000004566 .)
Author Ito, Yukiko, MD
Kawakubo, Kazumichi, MD
Kogure, Hirofumi, MD, PhD
Tada, Minoru, MD, PhD
Koike, Kazuhiko, MD, PhD
Sasaki, Takashi, MD, PhD
Hirano, Kenji, MD, PhD
Togawa, Osamu, MD, PhD
Yashima, Yoko, MD, PhD
Isayama, Hiroyuki, MD, PhD
Omata, Masao, MD, PhD
Nakai, Yousuke, MD, PhD
Toda, Nobuo, MD, PhD
Tsujino, Takeshi, MD, PhD
Sasahira, Naoki, MD, PhD
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Issue 4
Keywords covered self-expandable metal stent
AF
GOO
modified ComVi stent
PTFE
gastric outlet obstruction
expanded polytetrafluoroethylene
GOOSS
self-expandable metal stent
M-ComVi stent
axial force
CSEMS
SD
e-PTFE
gastric outlet obstruction scoring system
polytetrafluoroethylene
SEMS
standard deviation
Instrumentation therapy
Digestive diseases
Malignant tumor
Metal
Stomach cancer
Stent
Cancer
Gastric disease
Language English
License CC BY 4.0
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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Snippet Background A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially...
A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered,...
BACKGROUNDA high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially...
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SubjectTerms Aged
Alloys
Bile Duct Neoplasms - complications
Biological and medical sciences
Carcinoma - complications
Cholangiocarcinoma - complications
Digestive system. Abdomen
Endoscopy
Female
Gastric Outlet Obstruction - etiology
Gastric Outlet Obstruction - therapy
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Kaplan-Meier Estimate
Male
Medical sciences
Middle Aged
Pancreatic Neoplasms - complications
Prosthesis Failure
Stents - adverse effects
Stomach Neoplasms - complications
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Tumors
Title Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent
URI https://www.clinicalkey.es/playcontent/1-s2.0-S001651071102493X
https://dx.doi.org/10.1016/j.gie.2011.11.035
https://www.ncbi.nlm.nih.gov/pubmed/22284092
https://search.proquest.com/docview/948892942
Volume 75
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