Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients

Kim, Jin Hyoung; Song, Ho-Young; Shin, Ji Hoon; Choi, Eu Gene; Kim, Tae Won; Jung, Hwoon‐Yong; Lee, Gin Hyug; Lee, Sung Koo; Kim, Myung–Hwan; Ryu, Min‐Hee; Kang, Yoon‐Koo; Kim, Byung Sik; Yook, Jeong Hwan

doi:10.1016/j.gie.2006.12.017

Cited by 189 publications

(190 citation statements)

References 22 publications

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“…The reported rate for adverse events including stent dysfunction after deployment of SEMS for patients with malignant GOO is 15-48% ( Table 1) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The rates of stent dysfunction and other adverse events are 5-40% and 0-23%, respectively.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Ge et al described delayed migration of a WallFlex enteral stent with subsequent visceral perforation four months after SEMS deployment, which was connected with shrinking of the tumor by chemotherapy (20). Several reports did not find evidence of perforation as an adverse event (8,(10)(11)(12)14,18), and the risk of perforation is thought to be low. However, when it occurs perforation is directly associated with mortality, therefore, special attention should be paid to the possibility of perforation with a SEMS.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Table 1 shows clinical results of prospective and multicenter studies of endoscopic treatment using SEMS for patients with malignant GOO. These reports show a technical success rate for the endoscopic deployment of a SEMS in patients with malignant GOO ranging from 95-100% (Table 1) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Reasons for unsuccessful deployment of a SEMS included unsuccessful passage of the guidewire or stent delivery system because of severity of the stricture (8,12), perforation during the procedure (9,16), insufficient deployment (11), and functional problems with SEMSs (6).…”

Section: Introductionmentioning

confidence: 99%

“…These reports show a technical success rate for the endoscopic deployment of a SEMS in patients with malignant GOO ranging from 95-100% (Table 1) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Reasons for unsuccessful deployment of a SEMS included unsuccessful passage of the guidewire or stent delivery system because of severity of the stricture (8,12), perforation during the procedure (9,16), insufficient deployment (11), and functional problems with SEMSs (6). Though definitions of clinical success differ slightly among studies, the rates of clinical success, which are indicated by an improvement in the GOO ranged from 77-94% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…Reasons for unsuccessful deployment of a SEMS included unsuccessful passage of the guidewire or stent delivery system because of severity of the stricture (8,12), perforation during the procedure (9,16), insufficient deployment (11), and functional problems with SEMSs (6). Though definitions of clinical success differ slightly among studies, the rates of clinical success, which are indicated by an improvement in the GOO ranged from 77-94% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Median survival after deployment of a SEMS was reported to be approximately 3 months or less in most reports.…”

Section: Introductionmentioning

confidence: 99%

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Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

2017

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Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses.Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved.Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.

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