Palliation of Unresectable Gastric Outlet Obstruction with Self-Expandable Metal Stent

Kim, Young Seok; Ko, Bong Min; Cheon, Young Koog; Ryu, Chang Beom; Moon, Jong Ho; Cho, Young Deok; Kim, Jin Oh; Cho, Joo Young; Lee, Joong Seong; Lee, Moon Sung; Shim, Chan Sup

Abstract

BACKGROUND/AIMS
Placement of stents in cases of inoperable malignant gastric outlet obstruction is difficult due to anatomical and technical problems. The aim of this study was to assess the feasibility, effectiveness, safety, and long-term outcome of a self-expandable metal stent (SEMS) as a means of providing palliative care for patients with an inoperable malignant gastric outlet obstruction,
METHODS
Fifty-one consecutive patients (53 cases of stent insertion) with onoperable gastric outlet obstruction were treated palliatively with EsophaCoil, Choo's stent, or through-the-scope (TTS) stent.
RESULTS
Technical Success was achieved in 46 cases (86.8%). Six cases of stent insertion failure were caused by acute angulation of the stenotic area and sereve distal luminal narrowing. The other failed case was due to the inappropriate location of the stent. In 41 cases, the patients (89.1%) could ingest soft or solid foods after successful insertion of the stents. All the remaining 16 cases of TTS SEMS had technical and clinical successes. During the follow-up (mean; 3.3+/-1.1 months, range; 1~11 months), there was 1case of aspiration pneumonia, 1 case of bowel perforation, 2 cases of stent migration, and 2 cases of stent occlusion by tumor ingrowth.
CONCLUSIONS
Placement of a SEMS, especially TTS SEMS in patients with malignant gastric outlet obstruction is a feasible, effective, and safe palliative therapy.