New Methods: Clinical Endoscopy
Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study

https://doi.org/10.1016/j.gie.2006.11.060Get rights and content

Background

Through-the-scope (TTS) stents facilitate palliative enteral stent placement. However, most TTS stents are braided, a characteristic that has been associated with significant foreshortening and relatively frequent migration.

Objectives

To evaluate clinical experience with a new woven enteral stent in the treatment of gastric outlet obstruction.

Design

From January 2005 to August 2006, patients with unresectable malignant gastric outlet obstruction were offered stent placement with a new woven stent.

Setting

Three referral hospitals in Japan.

Patients

Thirty-seven consecutive patients with malignant gastric outlet obstruction.

Interventions

A newly designed enteral stent was placed by using the TTS placement technique.

Main Outcome Measurements

Palliation efficacy and safety of the new stents.

Results

Stent placement was successful in 36 of 37 patients (technical success, 97%). Thirty-four patients were able to tolerate oral intake without obstructive symptoms (clinical success, 94.4%). Complications occurred in 16.2% of patients, comprising 2 cases of primary stent dysfunction, 1 perforation, 1 GI bleeding, 1 stent obstruction, and 1 biliary stent dysfunction. No migration was seen during the median follow-up period of 68 days.

Limitations

Small sample size and relatively brief follow-up.

Conclusions

A newly developed enteral stent with higher flexibility and less foreshortening offers comparable clinical outcome to existing stents and a lower frequency of complications, including migration.

Section snippets

Patients

We conducted a multicenter study of patients undergoing enteral stent placement by using a newly designed enteral stent for unresectable malignant GOO. Patients were enrolled from January 2005 to August 2006 at 3 referral hospitals: Toho University Ohashi Medical Center, Tokyo; the University of Tokyo Hospital, Tokyo; and the National Hospital Organization Kyoto Medical Center, Kyoto. Inclusion criteria were documented malignancy, pyloroduodenal obstruction confirmed by radiography or

Results

A total of 37 consecutive patients (median age, 67 years; quartile 64-75.5 years) were enrolled from January 2005 to August 2006 (Table 1). The etiology of GOO was pancreatic, gastric, gallbladder, metastatic, or other malignancies. The site of obstruction was the duodenum in 20 patients, the pylorus in 14, the efferent limb after Child's operation in 2, and gastroduodenostomy after distal gastrectomy with Billroth I in 1. Of 20 patients with duodenal obstruction, 2 had undergone a distal

Discussion

The present study is the first to analyze the clinical experience with a newly designed enteral stent, the Niti-S enteral colonic stent and introducer. Results showed that this new woven stent, with higher flexibility and less foreshortening, offers comparable clinical outcomes to existing stents and a lower frequency of complications, including migration.

Malignant GOO remains a challenging clinical condition. The main goal of the treatment is amelioration of the obstructive symptoms and the

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