Yasuki Hori1, Itaru Naitoh1, Kazuki Hayashi1, Tesshin Ban1, Makoto Natsume2, Fumihiro Okumura3, Takahiro Nakazawa4, Hiroki Takada5, Atsuyuki Hirano6, Naruomi Jinno7, Shozo Togawa8, Tomoaki Ando9, Hiromi Kataoka1, Takashi Joh1. 1. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 2. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Gastroenterology, Midori Municipal Hospital, Nagoya, Japan. 3. Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 4. Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan. 5. Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan. 6. Department of Gastroenterology, Nagoya City West Medical Center, Nagoya, Japan. 7. Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan. 8. Department of Gastroenterology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan. 9. Department of Gastroenterology, Gamagori City Hospital, Gamagori, Japan.
Abstract
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.
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.
Authors: Jung Wan Choe; Jong Jin Hyun; Dong-Won Lee; Sang Jun Suh; Seung Young Kim; Sung Woo Jung; Young Kul Jung; Ja Seol Koo; Hyung Joon Yim; Sang Woo Lee Journal: Gastroenterol Res Pract Date: 2018-04-23 Impact factor: 2.260