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Digestive Diseases and Sciences

, Volume 53, Issue 4, pp 938–945 | Cite as

Clinical Outcomes and Patency of Self-expanding Metal Stents in Patients with Malignant Upper Gastrointestinal Obstruction

  • Jong Pil Im
  • Jung Mook Kang
  • Sang Gyun Kim
  • Joo Sung Kim
  • Hyun Chae Jung
  • In Sung Song
Original Paper

Abstract

This study was performed to evaluate clinical outcomes and factors associated with patency of self-expanding metal stents (SEMS) in patients with malignant upper gastrointestinal (UGI) obstruction. In 83 patients with malignant UGI obstruction, 118 SEMS placements were performed. Obstruction sites were esophagus/gastro-esophageal junction (GEJ) and gastric outlet (GO) in 41 and 42 patients, respectively. Technical success was achieved in 99.2% and clinical success in 90.5%, with no procedure-related complications. Re-obstruction and migration occurred in 38.1% during a mean follow-up of 137 days; both occurred significantly more often with GO than esophageal/GEJ obstruction (49.2% vs 23.9%). Patency rates of esophageal/GEJ obstruction were 93.5, 78.1 and 67.0% at 30, 90 and 180 days, respectively, and were significantly higher than those of GO obstruction—71.7, 51.8 and 32.5%. Palliative chemotherapy or radiation therapy was not associated with stent patency. Endoscopic SEMS placement is a safe and effective palliative treatment for malignant UGI obstruction, and complications or stent patency differed according to obstruction site.

Keywords

Esophageal cancer Gastric cancer Malignant obstruction Self-expanding metal stents Patency 

References

  1. 1.
    Baron TH (2001) Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344:1681–1687PubMedCrossRefGoogle Scholar
  2. 2.
    Siersema PD, Marcon N, Vakil N (2003) Metal stents for tumors of the distal esophagus and gastric cardia. Endoscopy 35:79–85PubMedCrossRefGoogle Scholar
  3. 3.
    Lillemoe KD, Pitt HA (1996) Palliation. Surgical and otherwise. Cancer 78:605–614PubMedGoogle Scholar
  4. 4.
    Simmons DT, Baron TH (2005) Endoluminal palliation. Gastrointest Endosc Clin N Am 15:467–484, viiiPubMedCrossRefGoogle Scholar
  5. 5.
    Sabharwal T, Morales JP, Salter R, Adam A (2005) Esophageal cancer: self-expanding metallic stents. Abdom Imaging 30:456–464PubMedCrossRefGoogle Scholar
  6. 6.
    Adler DG, Baron TH (2001) Endoscopic palliation of malignant dysphagia. Mayo Clin Proc 76:731–738PubMedGoogle Scholar
  7. 7.
    Luketich JD, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Nguyen NT (2000) Endoscopic photodynamic therapy for obstructing esophageal cancer: 77 cases over a 2-year period. Surg Endosc 14:653–657PubMedCrossRefGoogle Scholar
  8. 8.
    Singh SM, Reber HA (1989) Surgical palliation for pancreatic cancer. Surg Clin North Am 69:599–611PubMedGoogle Scholar
  9. 9.
    Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, Pitt HA, Yeo CJ (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:322–328; discussion 328–330PubMedCrossRefGoogle Scholar
  10. 10.
    Simmons DT, Baron TH (2005) Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol 2:365–374; quiz 361 p following 374PubMedCrossRefGoogle Scholar
  11. 11.
    Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057PubMedCrossRefGoogle Scholar
  12. 12.
    Baron TH (2005) Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am 15:757–771PubMedCrossRefGoogle Scholar
  13. 13.
    Truong S, Bohndorf V, Geller H, Schumpelick V, Gunther RW (1992) Self-expanding metal stents for palliation of malignant gastric outlet obstruction. Endoscopy 24:433–435PubMedGoogle Scholar
  14. 14.
    Nassif T, Prat F, Meduri B, Fritsch J, Choury AD, Dumont JL, Auroux J, Desaint B, Boboc B, Ponsot P, Cervoni JP (2003) Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 35:483–489PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    De Gregorio BT, Kinsman K, Katon RM, Morrison K, Saxon RR, Barton RE, Keller FS, Rosch J (1996) Treatment of esophageal obstruction from mediastinal compressive tumor with covered, self-expanding metallic z-stents. Gastrointest Endosc 43:483–489PubMedCrossRefGoogle Scholar
  17. 17.
    Bethge N, Sommer A, Vakil N (1998) Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents. Am J Gastroenterol 93:1829–1832PubMedCrossRefGoogle Scholar
  18. 18.
    Gupta NK, Boylan CE, Razzaq R, England RE, Mirra L, Martin DF (1999) Self-expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compression. Eur Radiol 9:1893–1897PubMedCrossRefGoogle Scholar
  19. 19.
    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
  20. 20.
    Laasch HU, Martin DF, Maetani I (2005) Enteral stents in the gastric outlet and duodenum. Endoscopy 37:74–81PubMedCrossRefGoogle Scholar
  21. 21.
    Mittal A, Windsor J, Woodfield J, Casey P, Lane M (2004) Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91:205–209PubMedCrossRefGoogle Scholar
  22. 22.
    Espinel J, Sanz O, Vivas S, Jorquera F, Munoz F, Olcoz JL, Pinedo E (2006) Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 20:1083–1087PubMedCrossRefGoogle Scholar
  23. 23.
    Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A (2003) A randomised prospective comparison of the flamingo wallstent and ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 52:922–926PubMedCrossRefGoogle Scholar
  24. 24.
    Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, Shields SJ, Ruymann FW, Van Dam J, Carr-Locke DL (2001) Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53:329–332PubMedGoogle Scholar
  25. 25.
    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
  26. 26.
    Lambert R (2003) Treatment of esophagogastric tumors. Endoscopy 35:118–126PubMedCrossRefGoogle Scholar
  27. 27.
    Park HS, Do YS, Suh SW, Choo SW, Lim HK, Kim SH, Shim YM, Park KC, Choo IW (1999) Upper gastrointestinal tract malignant obstruction: initial results of palliation with a flexible covered stent. Radiology 210:865–870PubMedGoogle Scholar
  28. 28.
    Do YS, Choo SW, Suh SW, Kang WK, Rhee PL, Kim K, Shim YM, Park KB, Han YH, Choo IW (2001) Malignant esophagogastric junction obstruction: palliative treatment with an antireflux valve stent. J Vasc Interv Radiol 12:647–651PubMedCrossRefGoogle Scholar
  29. 29.
    Vakil N, Morris AI, Marcon N, Segalin A, Peracchia A, Bethge N, Zuccaro G, Bosco JJ, Jones WF (2001) A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol 96:1791–1796PubMedCrossRefGoogle Scholar
  30. 30.
    Christie NA, Buenaventura PO, Fernando HC, Nguyen NT, Weigel TL, Ferson PF, Luketich JD (2001) Results of expandable metal stents for malignant esophageal obstruction in 100 patients: short-term and long-term follow-up. Ann Thorac Surg 71:1797–1801; discussion 1801–1792PubMedCrossRefGoogle Scholar
  31. 31.
    Homs MY, Steyerberg EW, Kuipers EJ, van der Gaast A, Haringsma J, van Blankenstein M, Siersema PD (2004) Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma. Endoscopy 36:880–886PubMedCrossRefGoogle Scholar
  32. 32.
    Verschuur EM, Homs MY, Steyerberg EW, Haringsma J, Wahab PJ, Kuipers EJ, Siersema PD (2006) A new esophageal stent design (niti-s stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc 63:134–140PubMedCrossRefGoogle Scholar
  33. 33.
    Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78PubMedCrossRefGoogle Scholar
  34. 34.
    Elphick DA, Smith BA, Bagshaw J, Riley SA (2005) Self-expanding metal stents in the palliation of malignant dysphagia: outcome analysis in 100 consecutive patients. Dis Esophagus 18:93–95PubMedCrossRefGoogle Scholar
  35. 35.
    Mosca F, Stracqualursi A, Portale TR, Consoli A, Latteri S (2000) Palliative treatment of malignant esophageal stenosis: the role of self-expanding stent endoscopic implantation. Dis Esophagus 13:301–304PubMedCrossRefGoogle Scholar
  36. 36.
    Wenger U, Johnsson E, Arnelo U, Lundell L, Lagergren J (2006) An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study. Surg Endosc 20:1675–1680PubMedCrossRefGoogle Scholar
  37. 37.
    Kim GH, Kang DH, Lee DH, Heo J, Song GA, Cho M, Yang US (2004) Which types of stent, uncovered or covered, should be used in gastric outlet obstructions? Scand J Gastroenterol 39:1010–1014PubMedCrossRefGoogle Scholar
  38. 38.
    Yoon CJ, Song HY, Shin JH, Bae JI, Jung GS, Kichikawa K, Lopera JE, Castaneda-Zuniga W (2006) Malignant duodenal obstructions: palliative treatment using self-expandable nitinol stents. J Vasc Interv Radiol 17:319–326PubMedCrossRefGoogle Scholar
  39. 39.
    Maosheng D, Ohtsuka T, Ohuchida J, Inoue K, Yokohata K, Yamaguchi K, Chijiiwa K, Tanaka M (2001) Surgical bypass versus metallic stent for unresectable pancreatic cancer. J Hepatobiliary Pancreat Surg 8:367–373PubMedCrossRefGoogle Scholar
  40. 40.
    Raikar GV, Melin MM, Ress A, Lettieri SZ, Poterucha JJ, Nagorney DM, Donohue JH (1996) Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer. Ann Surg Oncol 3:470–475PubMedCrossRefGoogle Scholar
  41. 41.
    Telford JJ, Carr-Locke DL, Baron TH, Tringali A, Parsons WG, Gabbrielli A, Costamagna G (2004) Palliation of patients with malignant gastric outlet obstruction with the enteral wallstent: outcomes from a multicenter study. Gastrointest Endosc 60:916–920PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jong Pil Im
    • 1
  • Jung Mook Kang
    • 1
  • Sang Gyun Kim
    • 1
  • Joo Sung Kim
    • 1
  • Hyun Chae Jung
    • 1
  • In Sung Song
    • 1
  1. 1.Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea

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