Hironari Kato1,2, Hirofumi Kawamoto3,4, Kazuya Matsumoto5,4, Ichiro Moriyama6,4, Hideki Kamada7,4, Koichiro Tsutsumi8, Daisuke Goto9, Nobuhiko Fukuba10, Kiyohito Kato7, Hiroki Sonoyama10, Hajime Isomoto5, Hiroyuki Okada8. 1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. katou-h@cc.okayama-u.ac.jp. 2. Hakushusanbi Endoscopic Workshop Group, Japan. katou-h@cc.okayama-u.ac.jp. 3. Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan. 4. Hakushusanbi Endoscopic Workshop Group, Japan. 5. Department of Gastroenterology, Tottori University Hospital, Yonago, Japan. 6. Division of Clinical study of Oncology, Shimane University School of Medicine, Izumo, Japan. 7. Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan. 8. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 9. Department of Gastroenterology and Hepatology, Tottori Municipal Hospital, Tottori, Japan. 10. Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.
Abstract
OBJECTIVES: Several studies report on the outcomes of self-expandable metallic stents (SEMSs) deployment for malignant gastric outlet obstruction (GOO). However, data was mostly based on the analysis of single-center studies including only a small number of patients. This study aimed to evaluate clinical outcomes after the deployment of SEMS in patients with malignant GOO and to compare the clinical outcomes of two metallic stents with different designs. METHODS: Altogether 125 consecutive patients from five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric/duodenal and WallFlex duodenal stents was also undertaken. RESULTS: Rates for clinical and technical success were 100% and 92.0%, respectively. The median stent patency and survival periods were 72.0 days (range 3-775 days) and 75.0 days (range 3-775 days), respectively. The rate of overall adverse events was 28.8%. The rate of stent dysfunction was 16.8%, and that of adverse events, except stent dysfunction was 12.0%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S stent was significantly higher than that for WallFlex stent (96.2% vs 84.8%, P = 0.023). CONCLUSIONS: We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral food intake. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.
OBJECTIVES: Several studies report on the outcomes of self-expandable metallic stents (SEMSs) deployment for malignant gastric outlet obstruction (GOO). However, data was mostly based on the analysis of single-center studies including only a small number of patients. This study aimed to evaluate clinical outcomes after the deployment of SEMS in patients with malignant GOO and to compare the clinical outcomes of two metallic stents with different designs. METHODS: Altogether 125 consecutive patients from five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric/duodenal and WallFlex duodenal stents was also undertaken. RESULTS: Rates for clinical and technical success were 100% and 92.0%, respectively. The median stent patency and survival periods were 72.0 days (range 3-775 days) and 75.0 days (range 3-775 days), respectively. The rate of overall adverse events was 28.8%. The rate of stent dysfunction was 16.8%, and that of adverse events, except stent dysfunction was 12.0%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S stent was significantly higher than that for WallFlex stent (96.2% vs 84.8%, P = 0.023). CONCLUSIONS: We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral food intake. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.
Authors: Rajesh Krishnamoorthi; Shivanand Bomman; Petros Benias; Richard A Kozarek; Joyce A Peetermans; Edmund McMullen; Ornela Gjata; Shayan S Irani Journal: Endosc Int Open Date: 2022-06-10