CardioVascular and Interventional Radiology

, Volume 35, Issue 5, pp 1129–1135 | Cite as

Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement

  • Ye Jin Lee
  • Jin Hyoung KimEmail author
  • Ho-Young Song
  • Jung-Hoon Park
  • Han Kyu Na
  • Pyeong Hwa Kim
  • Yong Fan
Clinical Investigation



To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC).


Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C.


Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10–119 days). Stent patency was preserved in six patients with clinical success until death.


Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.


Gastrointestinal Nonvascular interventions Obstruction 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Yoon KT, Kim JK, Kim do Y et al (2007) Role of 18F-fluorodeoxyglucose positron emission tomography in detecting extrahepatic metastasis in pretreatment staging of hepatocellular carcinoma. Oncology 72(Suppl 1):104–110PubMedCrossRefGoogle Scholar
  2. 2.
    Yuki K, Hirohashi S, Sakamoto M et al (1990) Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer 66:2174–2179PubMedCrossRefGoogle Scholar
  3. 3.
    Yang Y, Nagano H, Ota H et al (2007) Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery 141:196–202PubMedCrossRefGoogle Scholar
  4. 4.
    Tonolini M, Solbiati L, Ierace T et al (2002) Extrahepatic recurrence and second malignancies after treatment of hepatocellular carcinoma: spectrum of imaging findings. Radiol Med 103:196–205PubMedGoogle Scholar
  5. 5.
    Choi HJ, Cho BC, Sohn JH et al (2009) Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neurooncol 91:307–313PubMedCrossRefGoogle Scholar
  6. 6.
    Chen LT, Chen CY, Jan CM et al (1990) Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies. Endoscopy 22:118–123PubMedCrossRefGoogle Scholar
  7. 7.
    Lin CP, Cheng JS, Lai KH et al (2000) Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases. J Gastroenterol Hepatol 15:536–541PubMedCrossRefGoogle Scholar
  8. 8.
    Anthony PP (1973) Primary carcinoma of the liver: a study of 282 cases in Ugandan Africans. J Pathol 110:37–48PubMedCrossRefGoogle Scholar
  9. 9.
    Nakashima T, Okuda K, Kojiro M et al (1983) Pathology of hepatocellular carcinoma in Japan: 232 consecutive cases autopsied in ten years. Cancer 51:863–877PubMedCrossRefGoogle Scholar
  10. 10.
    Korkolis DP, Aggeli C, Plataniotis GD et al (2009) Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas. World J Gastroenterol 15:1134–1137PubMedCrossRefGoogle Scholar
  11. 11.
    Kato Y, Matsubara K, Akiyama Y et al (2011) Direct biliopancreatoduodenal invasion by hepatocellular carcinoma: report of the first resected case and review of the literature. Int J Clin Oncol 16:421–427PubMedCrossRefGoogle Scholar
  12. 12.
    Fujii K, Nagino M, Kamiya J et al (2004) Complete resection of hepatocellular carcinoma with direct invasion to the stomach remnant. J Hepatobiliary Pancreat Surg 11:441–444PubMedCrossRefGoogle Scholar
  13. 13.
    Jung GS, Song HY, Kang SG et al (2000) Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 216:758–763PubMedGoogle Scholar
  14. 14.
    Bessoud B, de Baere T, Denys A et al (2005) Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 16:247–253PubMedCrossRefGoogle Scholar
  15. 15.
    Jung GS, Song HY, Seo TS et al (2002) Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents. J Vasc Interv Radiol 13:275–283PubMedCrossRefGoogle Scholar
  16. 16.
    Baron TH, Harewood GC (2003) Enteral self-expandable stents. Gastrointest Endosc 58:421–433PubMedCrossRefGoogle Scholar
  17. 17.
    Baron TH (2001) Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344:1681–1687PubMedCrossRefGoogle Scholar
  18. 18.
    Holt AP, Patel M, Ahmed MM (2004) Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc 60:1010–1017PubMedCrossRefGoogle Scholar
  19. 19.
    Telford JJ, Carr-Locke DL, Baron TH et al (2004) Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc 60:916–920PubMedCrossRefGoogle Scholar
  20. 20.
    Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR (2004) Gastroduodenal stent placement: current status. Radiographics 24:1561–1573PubMedCrossRefGoogle Scholar
  21. 21.
    Del Piano M, Ballare M, Montino F et al (2005) Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc 61:421–426PubMedCrossRefGoogle Scholar
  22. 22.
    Kim JH, Song HY, Shin JH et al (2009) Metallic stent placement in the palliative treatment of malignant gastric outlet obstructions: primary gastric carcinoma versus pancreatic carcinoma. AJR Am J Roentgenol 193:241–247PubMedCrossRefGoogle Scholar
  23. 23.
    Kim JH, Song HY, Shin JH et al (2007) Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66:256–264PubMedCrossRefGoogle Scholar
  24. 24.
    Kim JH, Song HY, Hu HT et al (2010) Palliative treatment of malignant gastric outlet obstructions with a large-diameter metallic stent: prospective preliminary study. J Vasc Interv Radiol 21:1125–1128PubMedCrossRefGoogle Scholar
  25. 25.
    Cancer of the Liver Italian Program (CLIP) Investigators (1998) A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology 28:751–755CrossRefGoogle Scholar
  26. 26.
    Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550PubMedCrossRefGoogle Scholar
  27. 27.
    Yoon CJ, Song HY, Shin JH et al (2006) Malignant duodenal obstructions: palliative treatment using self-expandable nitinol stents. J Vasc Interv Radiol 17:319–326PubMedCrossRefGoogle Scholar
  28. 28.
    Simmons DT, Baron TH (2005) Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol 2:365–374PubMedCrossRefGoogle Scholar
  29. 29.
    Kaw M, Singh S, Gagneja H, Azad P (2003) Role of self-expandable metal stents in the palliation of malignant duodenal obstruction. Surg Endosc 17:646–650PubMedCrossRefGoogle Scholar
  30. 30.
    Lee EY, Bourke MJ, Williams SJ et al (2011) Severity of initial stent angulation predicts reintervention after successful palliative enteral stenting for malignant luminal obstruction. J Gastroenterol Hepatol 26:484–491PubMedCrossRefGoogle Scholar
  31. 31.
    Baerlocher MO, Asch MR, Dixon P et al (2008) Interdisciplinary Canadian guidelines on the use of metal stents in the gastrointestinal tract for oncological indications. Can Assoc Radiol J 59:107–122PubMedGoogle Scholar
  32. 32.
    Sabharwal T, Irani FG, Adam A (2007) Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 30:1–5PubMedCrossRefGoogle Scholar
  33. 33.
    Morgan R, Adam A (2001) Use of metallic stents and balloons in the esophagus and gastrointestinal tract. J Vasc Interv Radiol 12:283–297PubMedCrossRefGoogle Scholar
  34. 34.
    Hasegawa N, Kato K, Morita K et al (2003) Covered expandable metallic stent placement for hemostasis of colonic bleeding caused by invasion of gallbladder carcinoma. Endoscopy 35:178–180PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Ye Jin Lee
    • 1
  • Jin Hyoung Kim
    • 1
    Email author
  • Ho-Young Song
    • 1
  • Jung-Hoon Park
    • 1
  • Han Kyu Na
    • 1
  • Pyeong Hwa Kim
    • 1
  • Yong Fan
    • 1
    • 2
  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of RadiologyHaihe HospitalTianjinChina

Personalised recommendations