Outcomes after partially covered self-expandable metal stent placement for recurrent duodenal obstruction

Okamoto, Takeshi; Sasaki, Takashi; Yoshio, Toshiyuki; Mori, Chinatsu; Mie, Takafumi; Furukawa, Takaaki; Yamada, Yuto; Takeda, Tsuyoshi; Kasuga, Akiyoshi; Ozaka, Masato; Fujisaki, Junko; Sasahira, Naoki

doi:10.1007/s00464-022-09519-w

Cited by 3 publications

(6 citation statements)

References 28 publications

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“…This retrospective study demonstrated that second SEMS placement was safe and effective for the management of RGOO regardless of the type of SEMS, in consistent with the existing literature [ 12 , 15 , 17 , 18 , 19 , 20 ]. The incidence of RGOO, cumulative TRGOO, and stent patency rates at 1, 2, and 3 months were comparable between cSEMS and uSEMS.…”

Section: Discussionsupporting

confidence: 89%

“…Overall adverse events including procedure-related adverse events occurred in 15% and 17% of cases in cSEMS and uSEMS, respectively, which is similar to AEs of 20–25% with initial SEMS as well as second SEMS [ 8 , 9 , 12 , 15 , 17 , 19 , 20 ], suggesting the safety of second SEMS regardless of the SEMS type. However, we had six cases with gastroduodenal perforation in which a Wallflex stent was used in five out of six cases, at least as initial or second SEMS.…”

Section: Discussionmentioning

confidence: 54%

“…About 25–35% of gastroduodenal SEMS for malignant GOO developed RGOO for some reason [ 12 , 17 , 18 ]. To prevent RGOO by improving initial SEMS function is obviously essential, but to optimize reintervention for RGOO is also important.…”

Section: Discussionmentioning

confidence: 99%

“…We speculated that second cSEMS is advantageous especially in the setting of RGOO due to tumor ingrowth since it can prevent tumor ingrowth and be less prone to migration when placed with stent-in-stent fashion because of more friction between the two SEMS. A recent study by Okamoto et al reported a high migration rate of up to 20% in second cSEMS even after stent-in-stent placement [ 17 ], but all stents used in their study were cSEMS with a diameter of 20 mm. Meanwhile, 65% of cases underwent 24 mm cSEMS placement in our study.…”

Section: Discussionmentioning

confidence: 99%

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Second Covered and Uncovered Self-Expandable Metal Stents for Recurrent Gastric Outlet Obstruction: A Retrospective Comparative Study

Takahara

Nakai

Ishida

et al. 2023

JCM

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Background: Endoscopic self-expandable metal stent (SEMS) placement is a current mainstay for malignant gastric outlet obstruction (GOO), but symptomatic recurrence due to initial SEMS dysfunction commonly occurs. We aimed to compare the safety and effectiveness of second SEMS for recurrent GOO (RGOO). Methods: Between April 2006 and December 2022, a total of 95 cases with malignant RGOO undergoing second endoscopic SEMS placement were enrolled. Technical and clinical success rates, RGOO, time to RGOO (TRGOO), stent patency rate, adverse events (AE), and overall survival (OS) were retrospectively compared between covered and uncovered SEMS (cSEMS/uSEMS) groups. Risk factors for TRGOO were also explored. Results: Baseline characteristics were well balanced between cSEMS (n = 48) and uSEMS (n = 47) groups, except for the causes of the initial SEMS dysfunction. High technical and clinical success rates with a similar incidence of AE (15% vs. 17%, p = 0.78) and OS (median of 101 vs. 102 days, p = 0.68) were achieved in both groups. There were no statistical differences in cumulative incidence of RGOO (19% vs. 13%, p = 0.58), TRGOO (median, not reached in both groups, p = 0.57), and stent patency rates at 1, 2, and 3 months between the groups (60%, 47% and 26%, respectively vs. 70%, 55% and 38%, respectively). However, TRGOO tended to be longer in cSEMS in cases with RGOO due to tumor ingrowth (median, not reached vs. 111 days, p = 0.19). A Cox regression analysis demonstrated that chemotherapy after second SEMS placement was significantly associated with an improved TRGOO (the hazard ratio of 0.27 [95% confidence interval, 0.08–0.93], p = 0.03). Conclusions: Regardless of the type of SEMS, second SEMS placement was similarly safe and effective for RGOO. The type of second SEMS might be considered based on the cause of initial SEMS dysfunction.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Second Covered and Uncovered Self-Expandable Metal Stents for Recurrent Gastric Outlet Obstruction: A Retrospective Comparative Study

Takahara

Nakai

Ishida

et al. 2023

JCM

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“…Similar to a previous report on duodenal stenting, recurrent obstruction was defined as a composite endpoint of either SEMS occlusion or migration [ 13 ]. Time to recurrent obstruction was measured the day of SEMS placement to the date of diagnosis of recurrent obstruction.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction

Yonekura

Sasaki

Mie

et al. 2022

JCM

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Background: Malignant afferent loop obstruction (ALO) is rare condition and is difficult to manage. Endoscopic transluminal treatment has become easier with the advent of balloon-assisted enteroscopes with a large working channels and self-expandable metal stent (SEMS) with a 9 Fr delivery system. Methods: From July 2016 to March 2022, 22 patients with symptomatic malignant ALO who underwent endoscopic transluminal treatment (Initial cohort), of which 18 patients received endoscopic transluminal SEMS placement (SEMS cohort), were retrospectively evaluated. We evaluated outcomes of endoscopic transluminal treatment and long-term outcomes of SEMS placement for malignant ALO. Results: In the Initial cohort, technical and clinical success rates were both 95.5%. The median procedural time was 28.0 min. One case of guidewire-induced micro-perforation occurred as an early complication (4.5%). In the SEMS cohort, and no early complication was observed. Recurrent obstruction occurred in two cases (11.1%) during the follow-up period (median: 102 days). One was managed by additional SEMS placement and the other was treated conservatively. Conclusions: High technical and clinical success was achieved by endoscopic transluminal treatment with short procedural time for malignant ALO. Endoscopic SEMS placement also appears to be safe and effective, and additional SEMS placement can be considered in cases of re-obstruction.

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Antineoplastics

2023

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Outcomes after partially covered self-expandable metal stent placement for recurrent duodenal obstruction

Cited by 3 publications

References 28 publications

Second Covered and Uncovered Self-Expandable Metal Stents for Recurrent Gastric Outlet Obstruction: A Retrospective Comparative Study

Second Covered and Uncovered Self-Expandable Metal Stents for Recurrent Gastric Outlet Obstruction: A Retrospective Comparative Study

Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction

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