Skip to main content

Advertisement

SpringerLink
Log in

Malignant Gastroduodenal Obstruction: Treatment with Self-Expanding Uncovered Wallstent

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose: To retrospectively evaluate the clinical effectiveness of a self-expanding uncovered Wallstent in patients with malignant gastroduodenal obstruction. Materials and Methods: Under combined endoscopic and fluoroscopic guidance, 29 patients with a malignant gastroduodenal stenosis were treated with a self-expanding uncovered metallic Wallstent. A dysphagia score was assessed before and after the intervention to measure the success of this palliative therapy. The dysphagia score ranged between grade 0 to grade 4: grade 0 = able to tolerate solid food, grade 1 = able to tolerate soft food, grade 2 = able to tolerate thick liquids, grade 3 = able to tolerate water or clear fluids, and grade 4 = unable to tolerate anything perorally. Stent patency and patients survival rates were calculated. Results: The insertion of the gastroduodenal stent was technically successful in 28 patients (96.5%). After stenting, 25 patients (86.2%) showed clinical improvement by at least one score point. During follow-up, 22 (78.5%) of 28 patients showed no stent occlusion until death and did not have to undergo any further intervention. In six patients (20.6%), all of whom were treated with secondary stent insertions, occlusion with tumor ingrowth and/or overgrowth was observed after the intervention. The median period of primary stent patency in our study was 240 days. Conclusion: Placement of an uncovered Wallstent is clinically effective in patients with malignant gastroduodenal obstruction. Stent placement is associated with high technical success, good palliation effect, and high durability of stent function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Weaver DW, Wiencek RG, Bouwman DL, Walt AJ (1987) Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 102:608–613

    PubMed  CAS  Google Scholar 

  2. Isla AM, Worthington T, Kakkar AK, Williamson RC (2000) A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma. Dig Surg 17:143–146

    Article  PubMed  CAS  Google Scholar 

  3. Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA et al (1999) Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg 230:322–328

    Article  PubMed  CAS  Google Scholar 

  4. van Wagensveld BA, Coene PP, van Gulik TM et al (1997) Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients. Br J Surg 84:1402–1406

    Article  PubMed  Google Scholar 

  5. Meijer S, De Bakker OJ, Hoitsma HF (1983) Palliative resection in gastric cancer. J Surg Oncol 23:77–80

    Article  PubMed  CAS  Google Scholar 

  6. Monson JR, Donohue JH, McIlrath DC et al (1991) Total gastrectomy for advanced cancer. A worthwhile palliative procedure. Cancer 68:1863–1868

    Article  PubMed  CAS  Google Scholar 

  7. Smith JW, Brennan MF (1992) Surgical treatment of gastric cancer. Proximal, mid, and distal stomach. Surg Clin North Am 72:381–399

    PubMed  CAS  Google Scholar 

  8. Strecker EP, Boos I, Husfeldt KJ (1995) Malignant duodenal stenosis: palliation with peroral implantation of a self-expanding nitinol stent. Radiology 196:349–351

    PubMed  CAS  Google Scholar 

  9. Binkert CA, Jost R, Steiner A, Zollikofer CL (1996) Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses. Radiology 199:335–338

    PubMed  CAS  Google Scholar 

  10. de Baere T, Harry G, Ducreux M et al (1997) Self-expanding metallic stents as palliative treatment of malignant gastroduodenal stenosis. AJR 169:1079–1083

    PubMed  Google Scholar 

  11. Kim GH, Kang DH, Lee DH et al (2004) Which types of stent, uncovered or covered, should be used in gastric outlet obstructions? Scand J Gastroenterol 39:1010–1014

    Article  PubMed  CAS  Google Scholar 

  12. Profili S, Meloni GB, Bifulco V et al (2001) Self-expandable metal stents in the treatment of antro-pyloric and/or duodenal strictures. Acta Radiol 42:176–180

    Article  PubMed  CAS  Google Scholar 

  13. Pinto IT (1997) Malignant gastric and duodenal stenosis: palliation by peroral implantation of a self-expanding metallic stent. Cardiovasc Intervent Radiol 20:431–434

    Article  PubMed  CAS  Google Scholar 

  14. Bethge N, Breitkreutz C, Vakil N (1998) Metal stents for the palliation of inoperable upper gastrointestinal stenoses. Am J Gastroenterol 93:643–645

    Article  PubMed  CAS  Google Scholar 

  15. Nevitt AW, Vida F, Kozarek RA et al (1998) Expandable metallic prostheses for malignant obstructions of gastric outlet and proximal small bowel. Gastrointest Endosc 47:271–276

    Article  PubMed  CAS  Google Scholar 

  16. Yates MR, Morgan DE, Baron TH (1998) Palliation of malignant gastric and small intestinal strictures with self-expandable metal stents. Endoscopy 30:266–272

    Article  PubMed  Google Scholar 

  17. Soetikno RM, Lichtenstein DR, Vandervoort J et al (1998) Palliation of malignant gastric outlet obstruction using an endoscopically placed Wallstent. Gastrointest Endosc 47:267–270

    Article  PubMed  CAS  Google Scholar 

  18. Maetani I, Akatsuka S, Ikeda M et al (2005) Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol 40:932–937

    Article  PubMed  CAS  Google Scholar 

  19. Sabharwal T, Irani FG, Adam A, Cardiovascular and Interventional Radiological Society of Europe (2007) Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 30:1–5

    Google Scholar 

  20. 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 13:275–283

    Article  PubMed  Google Scholar 

  21. Binkert CA, Ledermann HP, Jost R, Zollikofer CL (1998) Metallic stenting of gastroduodenal and colonic stenoses. Abdom Imaging 23:580–586

    Article  PubMed  CAS  Google Scholar 

  22. Song HY, Yang DH, Kuh JH, Choi KC (1993) Obstructing cancer of the gastric antrum: palliative treatment with covered metallic stents. Radiology 187:357–358

    PubMed  CAS  Google Scholar 

  23. Mainar A, Tejero E, Maynar M et al (1996) Colorectal obstruction: treatment with metallic stents. Radiology 198:761–764

    PubMed  CAS  Google Scholar 

  24. Feretis C, Benakis P, Dimopoulos C et al (1996) Palliation of large-bowel obstruction due to recurrent rectosigmoid tumor using self-expandable endoprostheses. Endoscopy 28:319–322

    Article  PubMed  CAS  Google Scholar 

  25. Feretis C, Benakis P, Dimopoulos C et al (1997) Duodenal obstruction caused by pancreatic head carcinoma: palliation with self-expandable endoprostheses. Gastrointest Endosc 46:161–165

    Article  PubMed  CAS  Google Scholar 

  26. Feretis C, Benakis P, Dimopoulos C et al (1996) Palliation of malignant gastric outlet obstruction with self-expanding metal stents. Endoscopy 28:225–228

    Article  PubMed  CAS  Google Scholar 

  27. Morgan R, Adam A (2001) Use of metallic stents and balloons in the esophagus and gastrointestinal tract. J Vasc Interv Radiol 12:283–297

    Article  PubMed  CAS  Google Scholar 

  28. Zollikofer CL, Jost R, Schoch E, Decurtins M (2000) Gastrointestinal stenting. Eur Radiol 10:329–341

    Article  PubMed  CAS  Google Scholar 

  29. Zollikofer CL (2000) Stenting of upper and lower GI tract obstruction. Acta Gastroenterol Belg 63:165–168

    PubMed  CAS  Google Scholar 

  30. Jost RS, Jost R, Schoch E et al (2007) Colorectal stenting: an effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 30:433–400

    Article  PubMed  Google Scholar 

  31. Shrivastava V, Tariq O, Tiam R et al (2008) Palliation of obstructing malignant colonic lesions using self-expanding metal stents: a single-center experience. Cardiovasc Intervent Radiol 31:931–936

    Article  PubMed  Google Scholar 

  32. Truong S, Bohndorf V, Geller H et al (1992) Self-expanding metal stents for palliation of malignant gastric outlet obstruction. Endoscopy 24:433–435

    Article  PubMed  CAS  Google Scholar 

  33. Maetani I, Ogawa S, Hoshi H et al (1994) Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenoses. Endoscopy 26:701–704

    Article  PubMed  CAS  Google Scholar 

  34. Bessoud B, de Baere T, Denys A et al (2005) Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 16(2 pt 1):247–53

    PubMed  Google Scholar 

  35. 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 66:256–264

    Article  PubMed  Google Scholar 

  36. Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78

    Article  PubMed  Google Scholar 

  37. Nassif T, Prat F, Meduri B et al (2003) Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 35:483–489

    Article  PubMed  CAS  Google Scholar 

  38. Graber I, Dumas R, Filoche B et al, Société Française d’Endoscopie Digestive (SFED) (2007) The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy 39:784–787

    Google Scholar 

  39. Jung GS, Song HY, Kang SG et al (2000) Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 216:758–763

    PubMed  CAS  Google Scholar 

  40. Park KB, Do YS, Kang WK et al (2001) Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 219:679–683

    PubMed  CAS  Google Scholar 

  41. Song HY, Shin JH, Yoon CJ et al (2004) A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 15:1443–1449

    PubMed  Google Scholar 

  42. Moss AC, Morris E, Leyden J, MacMathuna P (2007) Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 19:1119–1124

    Article  PubMed  CAS  Google Scholar 

  43. Akinci D, Akhan O, Ozkan F et al (2007) Palliation of malignant biliary and duodenal obstruction with combined metallic stenting. Cardiovasc Intervent Radiol 30:1173–1177

    Article  PubMed  Google Scholar 

  44. Krokidis ME, Hatzidakis AA, Manousaki EG, Gourtsoyiannis NC (2008) Late migration of two covered biliary stents through a spontaneous bilioenteric fistula in a patient with malignant biliary obstruction. Cardiovasc Intervent Radiol 31:222–225

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Nicole Graf from the Clinical Trials Center, Center for Clinical Research, University of Zurich, who performed the statistical analysis. We also thank Wolfgang Herzig, who designed and drew the illustrations.

Author information

Authors and Affiliations

  1. Department of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Andreas Gutzeit, Christoph A. Binkert, Eric Schoch, Thomas Sautter & Christoph L. Zollikofer

  2. Department of Internal Medicine, Section of Gastroenterology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Res Jost

Authors
  1. Andreas Gutzeit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph A. Binkert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Schoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Sautter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Res Jost
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph L. Zollikofer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Gutzeit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gutzeit, A., Binkert, C.A., Schoch, E. et al. Malignant Gastroduodenal Obstruction: Treatment with Self-Expanding Uncovered Wallstent. Cardiovasc Intervent Radiol 32, 97–105 (2009). https://doi.org/10.1007/s00270-008-9445-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-008-9445-y

Keywords

Search

Navigation