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Digestive Diseases and Sciences

, Volume 55, Issue 3, pp 668–674 | Cite as

Clinical Outcomes of Self-Expandable Metal Stent and Prognostic Factors for Stent Patency in Gastric Outlet Obstruction Caused by Gastric Cancer

  • Yu Kyung Cho
  • Sang Woo Kim
  • Won Haeng Hur
  • Kwan Woo Nam
  • Jae Hyuck Chang
  • Jae Myung Park
  • In Seok Lee
  • Myung-Gyu Choi
  • In-Sik Chung
Original Article

Abstract

The aim of this study was to assess clinical outcomes of endoscopic stenting for a gastric outlet obstruction caused by gastric cancer and the prognostic factors for stent patency by reviewing medical records. Eighty-one stents were inserted into 75 patients (48 men, average age 66 years). The technical and clinical success rates were 98 and 87%, respectively. The median stent patency was 55 days (95% CI 40–70 days). The median survival was 79 days (95% CI 58–123 days). Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 25 cases (31%). Cox multivariate regression analysis showed that covered stents (odds ratio 0.29, 95% CI 0.11–0.76; P = 0.01) and chemotherapy after stent placement (odds ratio 0.34, 95% CI 0.13–0.91; P = 0.03) were significant prognostic factors for stent patency. This study found that endoscopic stenting is a safe and effective palliation treatment for malignant gastric outlet obstruction and a covered stent and chemotherapy are significant prognostic factors for stent patency.

Keywords

Gastric cancer Gastric outlet obstruction Self-expandable metal stent Patency 

References

  1. 1.
    Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344:1681–1687. doi: 10.1056/NEJM200105313442206.CrossRefPubMedGoogle Scholar
  2. 2.
    Tierney W, Chuttani R, Croffie J, et al. Enteral stent. Gastrointest Endosc. 2006;63:920–926. doi: 10.1016/j.gie.2006.01.015.CrossRefPubMedGoogle Scholar
  3. 3.
    Maetani I, Akatsuka S, Ikeda M, et al. Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol. 2005;40:932–937. doi: 10.1007/s00535-005-1651-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Del Piano M, Ballarè M, Montino F, et al. Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc. 2005;61:421–426. doi: 10.1016/S0016-5107(04)02757-9.CrossRefPubMedGoogle Scholar
  5. 5.
    Wong YT, Brams DM, Munson L, et al. Gastric outlet obstruction secondary to pancreatic cancer: surgical vs. endoscopic palliation. Surg Endosc. 2002;16:310–312. doi: 10.1007/s00464-001-9061-2.CrossRefPubMedGoogle Scholar
  6. 6.
    Kim TO, Kang DH, Kim GH, et al. Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer. World J Gastroenterol. 2007;13:916–920.PubMedGoogle Scholar
  7. 7.
    Lee SM, Kang DH, Kim GH, Park WI, Kim HW, Park JH. Self-expanding metallic stents for gastric outlet obstruction resulting from stomach cancer: a preliminary study with a newly designed double-layered pyloric stent. Gastrointest Endosc. 2007;66:1206–1210. doi: 10.1016/j.gie.2007.06.021.CrossRefPubMedGoogle Scholar
  8. 8.
    Telford JJ, Carr-Locke DL, Baron TH, et al. Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc. 2004;60:916–920. doi: 10.1016/S0016-5107(04)02228-X.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim JH, Song HY, Shin JH, et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc. 2007;66:256–264. doi: 10.1016/j.gie.2006.12.017.CrossRefPubMedGoogle Scholar
  10. 10.
    Im JP, Kang JM, Kim SG, Kim JS, Jung HC, Song IS. Clinical outcomes and patency of self-expanding metal stents in patients with malignant upper gastrointestinal obstruction. Dig Dis Sci. 2008;53:938–945. doi: 10.1007/s10620-007-9967-1.CrossRefPubMedGoogle Scholar
  11. 11.
    Adler DG, Merwat SN. Endoscopic approaches for palliation of luminal gastrointestinal obstruction. Gastroenterol Clin North Am. 2006;35:65–82. doi: 10.1016/j.gtc.2005.12.004.CrossRefPubMedGoogle Scholar
  12. 12.
    Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol. 2007;42:283–290. doi: 10.1007/s00535-006-2003-y.CrossRefPubMedGoogle Scholar
  13. 13.
    Kaw M, Singh S, Gagneja H, Azad P. Role of self-expandable metal stents in the palliation of malignant duodenal obstruction. Surg Endosc. 2003;17:646–650. doi: 10.1007/s00464-002-8527-1.CrossRefPubMedGoogle Scholar
  14. 14.
    Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18. doi: 10.1186/1471-230X-7-18.CrossRefPubMedGoogle Scholar
  15. 15.
    Yim HB, Jacobson BC, Saltzman JR, et al. Clinical outcome of the use of enteral stents for palliation. Gastrointest Endosc. 2001;53:329–332.PubMedGoogle Scholar
  16. 16.
    Wai CT, Ho KY, Yeoh KG, Lim SG. Palliation of malignant gastric outlet obstruction caused by gastric cancer with self-expandable metal stents. Surg Laparosc Endosc Percutan Tech. 2001;11:161–164. doi: 10.1097/00019509-200106000-00002.PubMedGoogle Scholar
  17. 17.
    Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36:543–550. doi: 10.1055/s-2004-814434.CrossRefPubMedGoogle Scholar
  18. 18.
    Lindsay JO, Andreyev HJ, Vlavianos P, Westaby D. Self-expanding metal stents for the palliation of malignant gastroduodenal obstruction in patients unsuitable for surgical bypass. Aliment Pharmacol Ther. 2004;19:901–905. doi: 10.1111/j.1365-2036.2004.01896.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Nassif T, Prat F, Meduri B, et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy. 2003;35:483–489. doi: 10.1055/s-2003-39661.CrossRefPubMedGoogle Scholar
  20. 20.
    Holt AP, Patel M, Ahmed MM. Palliation of patients with malignant gatroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc. 2004;60:1010–1017. doi: 10.1016/S0016-5107(04)02276-X.CrossRefPubMedGoogle Scholar
  21. 21.
    Seo EH, Jung MK, Park MJ, et al. Covered expandable nitinol stents for malignant gastroduodenal obstructions. J Gastroenterol Hepatol. 2008;23:1056–1062. doi: 10.1111/j.1440-1746.2007.05260.x.CrossRefPubMedGoogle Scholar
  22. 22.
    Jung GS, Song HY, Kang SG, et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology. 2000;216:758–763.PubMedGoogle Scholar
  23. 23.
    Jeong JY, Han JK, Kim AY, et al. Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients. AJR Am J Roentgenol. 2002;178:847–852.PubMedGoogle Scholar
  24. 24.
    Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointest Endosc. 2007;66:355–360. doi: 10.1016/j.gie.2006.11.060.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Yu Kyung Cho
    • 1
  • Sang Woo Kim
    • 1
  • Won Haeng Hur
    • 1
  • Kwan Woo Nam
    • 1
  • Jae Hyuck Chang
    • 1
  • Jae Myung Park
    • 1
  • In Seok Lee
    • 1
  • Myung-Gyu Choi
    • 1
  • In-Sik Chung
    • 1
  1. 1.Division of Gastroenterology, Department of Internal MedicineThe Catholic UniversitySeoulKorea

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