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Clinical outcomes of re-stenting in patients with stent malfunction in malignant gastric outlet obstruction

Surgical Endoscopy volume 30, pages 1372–1379 (2016)Cite this article

Abstract

Background and aims

Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastric outlet obstruction (GOO). The aim of this study was to evaluate the clinical outcomes of salvage SEMS for stent malfunction and to identify the prognostic factors for a longer patency.

Methods

A total of 108 patients who underwent a secondary salvage SEMS placement for a primary stent malfunction were retrospectively reviewed at the Seoul National University Hospital between August 2004 and May 2013. The duration of patency for salvage SEMS was defined as the time between salvage SEMS placement and the recurrence of obstructive symptoms that were confirmed either endoscopically or radiologically.

Results

The technical and clinical success rates for salvage SEMS were 100 and 82.4 % (95 % confidence interval [CI] 74.0–89.0), respectively. A salvage SEMS malfunction occurred in 29 (26.9 %) of the 108 patients. The median duration of patency for salvage SEMS was 59.5 days (range 3–928, 95 % CI 73.7–118.3). Longer SEMS patencies of more than 60 days were significantly associated with palliative chemotherapy (odds ratio = 2.539, 95 % CI 1.031–6.252, p = .043). For salvage SEMS, covered–uncovered stents had a longer patency duration, as compared with other combinations of primary and salvage stent types.

Conclusions

Longer patency durations for salvage SEMS were associated with palliative chemotherapy after salvage SEMS insertion. Salvage SEMS could be a feasible and effective treatment for primary stent malfunction in malignant GOO.

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Abbreviations

SEMS:

Self-expanding metal stents

GOO:

Gastric outlet obstruction

CI:

Confidence interval

GOOSS:

Gastric outlet obstruction scoring system

SD:

Standard deviation

BMI:

Body mass index

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Acknowledgments

This work was supported by a Grant from the Liver Research Institute, Seoul National University College of Medicine.

Disclosures

Eun Hyo Jin, Sang Gyun Kim, Ji Yeon Seo, Jong Pil Im, Joo Sung Kim, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

    Eun Hyo Jin & Ji Yeon Seo

  2. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-799, Korea

    Sang Gyun Kim, Jong Pil Im, Joo Sung Kim & Hyun Chae Jung

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  1. Eun Hyo Jin
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  2. Sang Gyun Kim
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  3. Ji Yeon Seo
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  4. Jong Pil Im
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Correspondence to Sang Gyun Kim.

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Jin, E.H., Kim, S.G., Seo, J.Y. et al. Clinical outcomes of re-stenting in patients with stent malfunction in malignant gastric outlet obstruction. Surg Endosc 30, 1372–1379 (2016). https://doi.org/10.1007/s00464-015-4338-z

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Keywords

  • Gastric outlet obstruction
  • Salvage
  • Self-expanding metal stent
  • Patency