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

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Abstract

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

SEMS:

Self-expandable metallic stent

MGOO:

Malignant gastric outlet obstruction

GOOSS:

Gastric outlet obstruction scoring system

ECOG:

Eastern Cooperative Oncology Group

UGI:

Upper gastrointestinal

CT:

Chemotherapy

RT:

Radiotherapy

SD:

Standard deviation

HR:

Hazard ratio

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Acknowledgments

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

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Bing-Wei Ye, Yun-Cheng Hsieh, Chung-Pin Li, Yee Chao, Ming-Chih Hou, Han-Chieh Lin & Kuei-Chuan Lee

  2. Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Bing-Wei Ye, Chung-Kai Chou, Yun-Cheng Hsieh, Chung-Pin Li, Yee Chao, Ming-Chih Hou, Han-Chieh Lin & Kuei-Chuan Lee

  3. Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan

    Bing-Wei Ye

  4. Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Ilan, Taiwan

    Chung-Kai Chou

  5. Endoscopic Diagnosis and Therapeutic Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Ming-Chih Hou

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  1. Bing-Wei Ye
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Corresponding author

Correspondence to Kuei-Chuan Lee.

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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.

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

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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). https://doi.org/10.1007/s10620-017-4534-x

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  • DOI: https://doi.org/10.1007/s10620-017-4534-x

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