Gut Liver.  2017 Jul;11(4):481-488. 10.5009/gnl16259.

A Novel Partially Covered Self-Expandable Metallic Stent with Proximal Flare in Patients with Malignant Gastric Outlet Obstruction

Affiliations
  • 1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. isayama-tky@umin.ac.jp
  • 2Department of Gastroenterology, JR Tokyo General Hospital, Tokyo, Japan.
  • 3Department of Gastroenterology, Toshiba Hospital, Tokyo, Japan.
  • 4Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
  • 5Department of Gastroenterology, Kanto Central Hospital, Tokyo, Japan.
  • 6Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan.

Abstract

BACKGROUND/AIMS
Endoscopic placement of self-expandable metal stents (SEMSs) has emerged as a palliative treatment for malignant gastric outlet obstruction (GOO). Although covered SEMSs can prevent tumor ingrowth, frequent migration of covered SEMSs may offset their advantages in preventing tumor ingrowth.
METHODS
We conducted this multicenter, single-arm, retrospective study at six tertiary referral centers to evaluate the safety and efficacy of a partially covered SEMS with an uncovered large-bore flare at the proximal end as an antimigration system in 41 patients with symptomatic malignant GOO. The primary outcome was clinical success, and the secondary outcomes were technical success, stent dysfunction, adverse events, and survival after stent placement.
RESULTS
The technical and clinical success rates were 100% and 95%, respectively. Stent dysfunctions occurred in 17 patients (41%), including stent migration in nine (23%), tumor ingrowth in one (2%), and tumor overgrowth in four (10%). Two patients (5%) developed adverse events: one pancreatitis and one perforation. No procedure-related death was observed.
CONCLUSIONS
A novel partially covered SEMS with a large-bore flare proximal end was safe and effective for malignant GOO but failed to prevent stent migration. Further research is warranted to develop a covered SEMS with an optimal antimigration system.

Keyword

Gastric outlet obstruction; Self expandable metal stent; Endoscopic stent placement

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Gastric Outlet Obstruction/etiology/*surgery
Humans
Male
Middle Aged
Palliative Care/*methods
Prosthesis Failure/etiology
Retrospective Studies
Self Expandable Metallic Stents/*adverse effects
Stomach Neoplasms/*complications
Treatment Outcome
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