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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2017

01-10-2017

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

Authors: 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, Takashi Joh

Published in: Surgical Endoscopy | Issue 10/2017

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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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Metadata
Title
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
Authors
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
Takashi Joh
Publication date
01-10-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 10/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5471-7

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