Peroral Intubation of a Self-expanding Coil Stent for Palliation of Unresectable Gastric Cancer with Antral Obstruction

Kim, Jin Hong; Kim, Young Jun; Yoo, Byeong Moo; Moon, Young Soo; Lee, Kwang Jae; Hahm, Ki Baik; Cho, Sung Won

Abstract

BACKGROUND
Peroral intubation of a self-expanding metal stent is usually difficult in malignant antral obstruction in patients with unresectable gastric cancer, due to the curved gastroduodenal structure. METHODS: The delivery catheter of a self-expanding nickel-titanium coil stent was modified, which was originally used in obstructive esophagocardial cancer. Peroral intubation of the coil stent was attempted in patients suffering from intractable vomiting due to unresectable gastric cancer with antral obstruction. RESULTS: Fifteen of 18 patients (83.3%) were successfully managed without immediate complications such as stent migration, serious bleeding, bowel perforation, and procedure- related mortality. One patient, who failed the peroral intubation, was managed by percutaneous intubation of the coil stent via the route of percutaneous endoscopic gastrostomy. After insertion of the coil stent, food ingestion and symptomatic improvement of vomiting was achieved in 15 (93.8%) of 16 patients. The mean survival time was 3.7 months (range, 1-10 months). No delayed stent migration and occlusion by tumor overgrowth occurred. Stent occlusion by food materials occurred in one patient during the follow-up period, which was corrected by endoscopic flushing. CONCLUSION: These results suggest that peroral intubation of a self-expanding coil stent is a safe and effective palliation for unresectable gastric cancer with antral obstruction.