Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study

• Published in: Gastrointestinal endoscopy 2015-07, Vol.82 (1), p.32-36.e1
• Main Authors: Oh, Dongwook, MD, Lee, Sang Soo, MD, PhD, Song, Tae Jun, MD, PhD, Choi, Jun-Ho, MD, Park, Do Hyun, MD, PhD, Seo, Dong-Wan, MD, PhD, Lee, Sung Koo, MD, PhD, Kim, Myung-Hwan, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Digestive System Neoplasms - complications; Endoscopy, Gastrointestinal; Female; Gastric Outlet Obstruction - etiology; Gastric Outlet Obstruction - therapy; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Palliative Care - methods; Pilot Projects; Retrospective Studies; Self Expandable Metallic Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.11.039

Background Duodenal stent placement has emerged as an effective and safe palliative treatment for patients with malignant gastroduodenal obstruction. An uncovered enteral stent, however, is susceptible to repeat stenosis because of tumor ingrowth. Although covering an enteral stent with a membrane prevents tumor ingrowth, stent migration continues to be a major unresolved problem. Partially covered metal stents may avoid both tumor ingrowth and stent migration. Objective To evaluate the clinical and technical efficacy and the safety of a partially covered duodenal stent for malignant gastroduodenal obstruction. Design Retrospective, observational study. Setting Tertiary-care medical center. Patients Twenty patients with malignant gastroduodenal obstruction received palliative treatment with partially covered duodenal stents. Interventions Endoscopic stent placement. Main Outcome Measurements Technical success, clinical success, patency, and adverse events. Results Stent placement was successful in all 20 patients (technical success rate, 100%), and symptoms improved in 19 (clinical success rate, 95%). The Gastric Outlet Obstruction Scoring System score improved significantly ( P  < .001). Eight patients (40%) developed tumor overgrowth, whereas none showed stent migration. Median stent patency was 79.5 days (range 13-198 days). Adverse events occurred in 3 patients, including 2 with transient bacteremia and 1 with asphyxia because of impaction of food material into the stent. Limitations Single center, retrospective design, and a small number of patients. Conclusion Partially covered duodenal stents were effective and safe for malignant gastroduodenal obstruction and may prevent tumor ingrowth and stent migration.