Skip to main content
Log in

Metallic Stent Expansion Rate at Day One Predicts Stent Patency in Patients with Gastric Outlet Obstruction

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript


Background and Aims

Self-expandable metallic stent insertion has been a mainstream treatment for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO), a late-stage complication of gastrointestinal malignancies. This study aims to investigate the predictive value of stent expansion rates in clinical outcomes in patients with MGOO.


Eighty-seven patients with inoperable MGOO receiving metallic stents were reviewed retrospectively from April 2010 to December 2014. Clinical outcomes, predictors of stent patency, and survival were analyzed.


The technical and clinical success rates were 100 and 94.3%, respectively. The median stent patency time was 114 days (range 13–570 days). The median survival time was 133 days (range 13–1145 days). Stent dysfunctions occurred in 28 patients (32.2%), with restenosis accounting for the majority (82%). The stent expansion rate ≥75% at Day 1 predicted the stent patency [hazard ratio (HR) 0.12, P = 0.04]. However, it did not correlate with survival. Non-gastric cancer origins (HR 2.41, P = 0.002) and peritoneal carcinomatosis (HR 2.54, P = 0.001) correlated with poor survival. However, post-stent chemotherapy (HR 0.55, P = 0.03) was related to better outcome. The comparison of clinical outcomes of first and second stent insertions showed no significant difference in the stent expansion rate either at Day 0 and Day 1 (P = 0.97 and P = 0.57).


Self-expandable metallic stent insertion is a safe and effective treatment for relieving the obstructive symptoms. The stent expansion rate ≥75% at Day 1 is a novel stent-related predictor of stent patency.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others



Self-expandable metallic stent


Malignant gastric outlet obstruction


Gastric outlet obstruction scoring system


Eastern Cooperative Oncology Group


Upper gastrointestinal






Standard deviation


Hazard ratio


  1. Del Piano M, Ballare M, Montino F, et al. Endoscopy or surgery for malignant GI outlet obstruction? Gastrointest Endosc. 2005;61:421–426.

    Article  PubMed  Google Scholar 

  2. Espinel J, Sanz O, Vivas S, et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc. 2006;20:1083–1087.

    Article  CAS  PubMed  Google Scholar 

  3. Roy A, Kim M, Christein J, Varadarajulu S. Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs. Surg Endosc. 2012;26:3114–3119.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol. 2007;42:283–290.

    Article  PubMed  Google Scholar 

  5. Fiori E, Lamazza A, Volpino P, et al. Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004;24:269–271.

    PubMed  Google Scholar 

  6. Jeurnink SM, Steyerberg EW, van Hooft JE, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010;71:490–499.

    Article  PubMed  Google Scholar 

  7. Mehta S, Hindmarsh A, Cheong E, et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc. 2006;20:239–242.

    Article  CAS  PubMed  Google Scholar 

  8. Jeon HH, Park CH, Park JC, et al. Carcinomatosis matters: clinical outcomes and prognostic factors for clinical success of stent placement in malignant gastric outlet obstruction. Surg Endosc. 2014;28:988–995.

    Article  PubMed  Google Scholar 

  9. Sasaki T, Isayama H, Nakai Y, et al. Predictive factors of solid food intake in patients with malignant gastric outlet obstruction receiving self-expandable metallic stents for palliation. Dig Endosc. 2012;24:226–230.

    Article  PubMed  Google Scholar 

  10. Sato T, Hara K, Mizuno N, et al. Gastroduodenal stenting with Niti-S stent: long-term benefits and additional stent intervention. Dig Endosc. 2015;27:121–129.

    Article  PubMed  Google Scholar 

  11. Ye BW, Lee KC, Hsieh YC, et al. Self-expandable metallic stent placement in malignant gastric outlet obstruction: a comparison between 2 brands of stents. Medicine. 2015;94:e1208.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hori Y, Naitoh I, Ban T et al. Stent underexpansion on the procedure day is a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol. 2015;30:1246–1251.

    Article  PubMed  Google Scholar 

  13. Piesman M, Kozarek RA, Brandabur JJ, et al. Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol. 2009;104:2404–2411.

    Article  PubMed  Google Scholar 

  14. Kim SH, Chun HJ, Yoo IK, et al. Predictors of the patency of self-expandable metallic stents in malignant gastroduodenal obstruction. World J Gastroenterol WJG. 2015;21:9134–9141.

    Article  PubMed  Google Scholar 

  15. Canena JM, Lagos AC, Marques IN, et al. Oral intake throughout the patients’ lives after palliative metallic stent placement for malignant gastroduodenal obstruction: a retrospective multicentre study. Eur J Gastroenterol Hepatol. 2012;24:747–755.

    Article  CAS  PubMed  Google Scholar 

  16. Kim CG, Choi IJ, Lee JY, et al. Outcomes of second self-expandable metallic stent insertion for malignant gastric outlet obstruction. Surg Endosc. 2014;28:281–288.

    Article  PubMed  Google Scholar 

  17. Sasaki T, Isayama H, Nakai Y, et al. Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction. Dig Endosc. 2015;27:37–43.

    Article  PubMed  Google Scholar 

Download references


We thank Mr. Liao Dong-Ming for his excellent technical assistance.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kuei-Chuan Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by Institutional Review Board of Taipei Veterans General Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ye, BW., Chou, CK., Hsieh, YC. et al. Metallic Stent Expansion Rate at Day One Predicts Stent Patency in Patients with Gastric Outlet Obstruction. Dig Dis Sci 62, 1286–1294 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: