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Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents

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Abstract

Background

Endoscopic metallic stenting is widely accepted as a palliation therapy for malignant gastric outlet obstruction (GOO). However, the predictors of stent dysfunction have not been clarified. We aimed to evaluate the predictors, especially tumor ingrowth in uncovered self-expandable metallic stents (U-SEMS) and migration of covered self-expandable metallic stents (C-SEMS), which are the main causes related to the stent characteristics.

Methods

In this multicenter retrospective study, we compared patients with U-SEMS and C-SEMS in terms of clinical outcomes, and predictors of stent dysfunction.

Results

In total, 252 patients (126 with U-SEMS and 126 with C-SEMS) were enrolled. There were no significant differences in technical success, clinical success, GOO score, or time to stent dysfunction. Tumor ingrowth was significantly more frequent in U-SEMS (U-SEMS, 11.90% vs. C-SEMS, 0.79%; p = 0.002), and stent migration was significantly more frequent for C-SEMS (C-SEMS, 8.73% vs. U-SEMS, 0.79%; p = 0.005). Karnofsky performance status (p = 0.04), no presence of ascites (p = 0.02), and insufficient (<30%) stent expansion (p = 0.003) were significantly associated with tumor ingrowth in U-SEMS. Meanwhile, a shorter stent length (p = 0.05) and chemotherapy (p = 0.03) were predictors of C-SEMS migration.

Conclusions

Both U-SEMS and C-SEMS are effective with comparable patencies. Tumor ingrowth and stent migration are the main causes of stent dysfunction for U-SEMS and C-SEMS, respectively. With regard to stent dysfunction, U-SEMS might be a good option for patients receiving chemotherapy, while C-SEMS with longer stents for patients in good condition. (Clinical trial registration number: UMIN000024059).

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Acknowledgements

We are indebted to Katsuyuki Miyabe, Hiromu Kondo, Michihiro Yoshida, Shuichiro Umemura, Akihisa Kato, Hitoshi Sano, Shuya Shimizu, Tomonori Yamada, Hiroaki Yamashita, Hirotaka Ohara, and Shigehisa Osawa for providing case information.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku Nagoya, 467-8601, Japan

    Yasuki Hori, Itaru Naitoh, Kazuki Hayashi, Tesshin Ban, Makoto Natsume, Hiromi Kataoka & Takashi Joh

  2. Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan

    Fumihiro Okumura

  3. Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Takahiro Nakazawa

  4. Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan

    Hiroki Takada

  5. Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan

    Atsuyuki Hirano

  6. Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan

    Naruomi Jinno

  7. Department of Gastroenterology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan

    Shozo Togawa

  8. Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan

    Tomoaki Ando

  9. Department of Gastroenterology, Midori Municipal Hospital, Nagoya, Japan

    Makoto Natsume

Authors
  1. Yasuki Hori
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  2. Itaru Naitoh
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  3. Kazuki Hayashi
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  4. Tesshin Ban
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  7. Takahiro Nakazawa
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  8. Hiroki Takada
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  9. Atsuyuki Hirano
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  10. Naruomi Jinno
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  11. Shozo Togawa
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  12. Tomoaki Ando
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  13. Hiromi Kataoka
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  14. Takashi Joh
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Corresponding author

Correspondence to Itaru Naitoh.

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Disclosures

Drs. Yasuki Hori, Itaru Naitoh, Kazuki Hayashi, Tesshin Ban, Makoto Natsume, Fumihiro Okumura, Takahiro Nakazawa, Hiroki Takada, Atsuyuki Hirano, Naruomi Jinno, Shozo Togawa, Tomoaki Ando, Hiromi Kataoka, and Takashi Joh have no conflicts of interest of financial.

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Hori, Y., Naitoh, I., Hayashi, K. et al. Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents. Surg Endosc 31, 4165–4173 (2017). https://doi.org/10.1007/s00464-017-5471-7

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