Background and Aims
Uncovered self-expandable metal stents (U-SEMSs) and covered self-expandable metal
stents (C-SEMSs) are available for palliative therapy for malignant gastric outlet
obstruction (GOO). However, clinical differences and indications between the 2 types
of SEMSs have not been elucidated.
Methods
We retrospectively compared 126 patients with U-SEMS and 126 patients with C-SEMSs
with regard to clinical outcome and factors predictive of clinical improvement after
SEMSs placement.
Results
No significant difference was observed between the U-SEMS and C-SEMS groups with respect
to technical success, clinical success, GOO score, or time to stent dysfunction. Stent
migration was significantly more frequent in patients with C-SEMSs (U-SEMSs, .79%;
C-SEMSs, 8.73%; P = .005). Karnofsky performance status, chemotherapy, peritoneal dissemination, and
stent expansion ≤ 30% were associated significantly with poor GOO score improvement
in multivariable analyses, but stent type was not (P = .213). In subgroup analyses, insufficient (≤30%) stent expansion was an independent
factor in patients with U-SEMSs (P = .041) but not C-SEMSs. In the insufficient stent expansion subgroup, C-SEMSs was
associated significantly with superior clinical improvement compared with U-SEMSs
(P = .01). Insufficient stent expansion was observed more frequently in patients with
GI obstruction because of anastomotic sites or metastatic cancer (44.8% [13/29], P = .001).
Conclusions
No clinical difference, apart from stent migration, was observed between patients
with U-SEMSs and C-SEMSs. GI obstruction because of an anastomotic site or metastatic
cancer may be an indication for C-SEMS use to improve oral intake after SEMSs placement.
Abbreviations:
CI (confidence interval), C-SEMS (covered self-expandable metal stent), GOO (gastric outlet obstruction), KPS (Karnofsky performance status), OR (odds ratio), U-SEMS (uncovered self-expandable metal stent)To read this article in full you will need to make a payment
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References
- Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.N Engl J Med. 2001; 344: 1681-1687
- Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction.Gastrointest Endosc. 2001; 53: 329-332
- Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness.Endoscopy. 2004; 36: 543-550
- Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction.J Gastroenterol Hepatol. 2015; 30: 1246-1251
- Clinical evaluation of covered self-expandable metallic stent for unresectable malignant stomach pyloric region and duodenal obstruction [In Japanese].Jpn J Gastroenterol. 2006; 103 ([In Japanese]): 405-414
- Endoscopic retrograde cholangiopancreatography-related adverse events in patients with type 1 autoimmune pancreatitis.Pancreatology. 2016; 16: 78-82
- Predictive factors for positive diagnosis of malignant biliary strictures by transpapillary brush cytology and forceps biopsy.J Dig Dis. 2016; 17: 44-51
- Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients.J Gastroenterol Hepatol. 2014; 29: 648-652
- 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
- Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial.Am J Gastroenterol. 2009; 104: 2404-2411
- Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review.BMC Gastroenterol. 2007; 7: 18
- The efficacy and safety of duodenal stenting: a prospective multicenter study.Endoscopy. 2007; 39: 784-787
- Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study.Gastrointest Endosc. 2009; 69: 1059-1066
- Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies.Endoscopy. 2004; 36: 73-78
- Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy.J Gastroenterol. 2005; 40: 932-937
- Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study.Gastrointest Endosc. 2010; 72: 25-32
- Covered versus uncovered self-expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis.BMC Gastroenterol. 2014; 14: 170
- Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents.Scand J Gastroenterol. 2009; 44: 846-852
- Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients.AJR Am J Roentgenol. 2002; 178: 847-852
- Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: a multicenter randomized trial.Dig Endosc. 2014; 26: 192-199
- Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: a randomized prospective study.Dig Liver Dis. 2014; 46: 603-608
- 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
- Gastroduodenal stenting with Niti-S stent: long-term benefits and additional stent intervention.Dig Endosc. 2015; 27: 121-129
- Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients.Am J Gastroenterol. 2002; 97: 72-78
- Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer.World J Gastroenterol. 2007; 13: 916-920
- Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients.Gastrointest Endosc. 2007; 66: 256-264
- Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent.Gastrointest Endosc. 2012; 75: 757-763
- Japanese multicenter estimation of WallFlex duodenal stent for unresectable malignant gastric outlet obstruction.Dig Endosc. 2013; 25: 1-6
- Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study.Gastrointest Endosc. 2014; 79: 66-75
- Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial.Am J Gastroenterol. 2015; 110: 1440-1449
- Self-expandable metallic stent placement in malignant gastric outlet obstruction: a comparison between 2 brands of stents.Medicine. 2015; 94: e1208
- Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction.Surg Endosc. 2015;
- Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction.World J Gastroenterol. 2015; 21: 1580-1587
- Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan.Gastrointest Endosc. 2016;
- Over-the-wire versus through-the-scope stents for the palliation of malignant gastric outlet obstruction: a retrospective comparison study.Eur Radiol. 2016;
- Factors associated with clinical failure of self-expandable metal stent for malignant gastroduodenal obstruction.Scand J Gastroenterol. 2016; 51: 103-110
- New concept of traction force applied to biliary self-expandable metallic stents.Endoscopy. 2016;
- Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents.Gastrointest Endosc. 2007; 65: 782-787
Article info
Publication history
Published online: July 27, 2016
Accepted:
July 1,
2016
Received:
April 16,
2016
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 427.
Identification
Copyright
© 2017 by the American Society for Gastrointestinal Endoscopy
