Comparison of big funnel and individualized stents for management of stomach cancer with gastric outlet obstruction

Ding, Shilei; Liu, Jianping; Hu, Xujun; Liu, Yongpan; Ji, Feng; Bao, Yin-su; Guo, Daxin

doi:10.1097/md.0000000000013194

Cited by 2 publications

(5 citation statements)

References 38 publications

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“…The present study demonstrated that the big end double-layer uncovered SEMS had a good performance in preventing stent obstruction and migration. The incidence of stent obstruction, food impaction, and reinterventional rate was 1.4%, 2.9%, and 4.3%, respectively, which were similar to the individualized and funnel covered SEMS [ 10 , 19 ] , but much lower compared with other reports [20, 21]. Unlike the individualized and funnel SEMS [10, 19], neither distal nor proximal migration of the big end double-layer SEMS was not found in this study.…”

Section: Discussionsupporting

confidence: 75%

“…The incidence of stent obstruction, food impaction, and reinterventional rate was 1.4%, 2.9%, and 4.3%, respectively, which were similar to the individualized and funnel covered SEMS [ 10 , 19 ] , but much lower compared with other reports [20, 21]. Unlike the individualized and funnel SEMS [10, 19], neither distal nor proximal migration of the big end double-layer SEMS was not found in this study. In addition, the mean survival time of patients in this study was longer than those in other reports [22, 23].…”

Section: Discussionsupporting

confidence: 75%

“…Moreover, the improvement of GOOSS score was obvious after stent implantation, which mainly depended on the shaping effect of the big cup of stent and the coverage of the proximal obstructive lesions by the big cup of stent. Because the big end stent was not only fitting well in the remnant stomach cavity but also providing a good pathway for the passage of food [10, 19], only two cases of food obstruction occurred in this study, which might be related to the food adhesion caused by the nonsmooth wall of the uncovered stents.…”

Section: Discussionmentioning

confidence: 99%

“…The mean cost of treatment with the big end double-layer uncovered SEMS was $2,945, which was higher than that with the individualized or funnel SEMS in China [10, 19]. Although the cost of the big end double-layer uncovered SEMS was higher, it was cost-efficient for the long-term run due to its lower reintervention rate (4.3%) and longer survival time (212.5 days) compared with monolayer SEMS [24–27].…”

Section: Discussionmentioning

confidence: 99%

“…In our previous studies, the big funnel covered SEMS were designed according to the sizes of the proximal end of GOO. The designed stents had excellent lesion coverage and shaping effect and were superior to other stents in terms of survival time, cost of stent treatment, and preventing stent migration or reobstruction [10, 11]. However, the big funnel and individualized covered SEMS cannot be implanted by endoscopic channel (through-the-scope (TTS)).…”

Section: Introductionmentioning

confidence: 99%

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Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Ding

Liu

et al. 2019

Gastroenterology Research and Practice

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Objectives. This study is aimed at evaluating the efficacy and safety of the big end double-layer uncovered self-expanding metal stents (SEMS) for the treatment of gastric outlet obstruction (GOO) caused by distal stomach cancer. Methods. Seventy three patients receiving big end double-layer uncovered SEMS for the treatment of GOO caused by distal gastric cancer will be included in this multicenter prospective clinical trial. The main outcome measures included the functional outcome, the complications, the reinterventional rates, the average treatment charges, and the mean survival time. Monthly telephone calls were needed to assess the food intake until the patients died. Results. The technical and the clinical success rates were 98.6%. The stent obstruction caused by tumor ingrowth was observed in one patient (1.4%). The incidence of food impaction was 2.9% (2/70) and the reinterventional rate was 4.3% (3/70). However, stent migration and obstruction caused by overgrowth were not observed. No perforation and severe bleeding were observed. The median cost of endoscopic stenting and total hospitalization (including reinterventions) for the big end double-layer uncovered SEMS in this study was $2945 and $3408, respectively. The mean survival time was 212.5 days. Conclusions. The placement of big end double-layer uncovered SEMS is a safe and effective modality and has the potential to be one of the options for the treatment of GOO caused by the distal gastric cancer.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Ding

Liu

et al. 2019

Gastroenterology Research and Practice

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Self-expandable metal stent of esophagogastric junction versus pyloric area obstruction in advanced gastric cancer patients

et al. 2020

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Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions. To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer. Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement. The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement ( P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] ( P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement. The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.

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Comparison of big funnel and individualized stents for management of stomach cancer with gastric outlet obstruction

Abstract: Supplemental Digital Content is available in the text

Cited by 2 publications

References 38 publications

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

Self-expandable metal stent of esophagogastric junction versus pyloric area obstruction in advanced gastric cancer patients

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