Gastroduodenal Stenting with a Flexible Stent Demonstrates Favorable Clinical Effectiveness Despite Gradual Expansion: A Multicenter Prospective Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Feb 11

PMID 36769496

Authors

Hiroaki Shigoka

Masao Toki

Sho Takahashi

Naminatsu Takahara

Katsuya Kitamura

Eisuke Iwasaki

Kazunari Nakahara

Hiroyuki Isayama

Yousuke Nakai

Iruru Maetani

Affiliations

Soon will be listed here.

Abstract

Aims: This study aimed to evaluate the effectiveness and safety of stenting with a flexible braided self-expandable metal stent (SEMS) for unresectable malignant gastric outlet obstruction (GOO).

Methods: Palliative stenting was prospectively carried out at seven university hospitals between October 2017 and August 2020. All procedures were performed using a flexible branded SEMS of the same brand. The primary endpoint was clinical success rate at 7 days after stenting. Secondary endpoints were procedural success rate, adverse events, recurrent gastric outlet obstruction (RGOO), and patient survival time.

Results: Sixty patients were enrolled. The procedural and clinical success rates were 100% and 90%, respectively. RGOO occurred in 15 cases (25%). Adverse events other than RGOO were found in seven cases (12%). The 50% survival time was 75.5 days (range: 52-97 days). Median expansion rates at 1, 3, and 7 days after stenting were 55%, 65%, and 75%, respectively.

Conclusions: A flexible braided stent woven with relatively thin wires was used for malignant GOO. Despite a gradual expansion with slightly lower expansile force, the stent functioned sufficiently well and showed favorable results. Clinical Trials Registry ID: UMIN000029496.

References

Shin Y, Choi C, Kang D, Kim H, Kim S, Cho M . Factors associated with clinical failure of self-expandable metal stent for malignant gastroduodenal obstruction. Scand J Gastroenterol. 2015; 51(1):103-10. DOI: 10.3109/00365521.2015.1064992. View

Dormann A, Meisner S, Verin N, Wenk Lang A . Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004; 36(6):543-50. DOI: 10.1055/s-2004-814434. View

Hori Y, Naitoh I, Ban T, Narita K, Nakazawa T, Hayashi K . Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol. 2015; 30(8):1246-51. DOI: 10.1111/jgh.12933. View

Miwa H, Sugimori K, Kaneko T, Ishii T, Iwase S, Irie K . Clinical outcome of a highly flexible duodenal stent for gastric outlet obstruction: A multicenter prospective study. JGH Open. 2020; 4(4):729-735. PMC: 7411653. DOI: 10.1002/jgh3.12326. View

Maetani I, Mizumoto Y, Shigoka H, Omuta S, Saito M, Tokuhisa J . Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: a multicenter randomized trial. Dig Endosc. 2013; 26(2):192-9. DOI: 10.1111/den.12117. View

Hori Y, Naitoh I, Hayashi K, Ban T, Natsume M, Okumura F . Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents. Surg Endosc. 2017; 31(10):4165-4173. DOI: 10.1007/s00464-017-5471-7. View

Adler D, Baron T . Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002; 97(1):72-8. DOI: 10.1111/j.1572-0241.2002.05423.x. View

Ye B, Chou C, Hsieh Y, Li C, Chao Y, Hou M . Metallic Stent Expansion Rate at Day One Predicts Stent Patency in Patients with Gastric Outlet Obstruction. Dig Dis Sci. 2017; 62(5):1286-1294. DOI: 10.1007/s10620-017-4534-x. View

Sasaki T, Isayama H, Maetani I, Nakai Y, Kogure H, Kawakubo K . Japanese multicenter estimation of WallFlex duodenal stent for unresectable malignant gastric outlet obstruction. Dig Endosc. 2013; 25(1):1-6. DOI: 10.1111/j.1443-1661.2012.01319.x. View

10.

Costamagna G, Tringali A, Spicak J, Mutignani M, Shaw J, Roy A . Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis. 2011; 44(1):37-43. DOI: 10.1016/j.dld.2011.08.012. View

11.

Jeurnink S, van Eijck C, Steyerberg E, Kuipers E, Siersema P . Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007; 7:18. PMC: 1904222. DOI: 10.1186/1471-230X-7-18. View

12.

Okuwaki K, Kida M, Yamauchi H, Imaizumi H, Miyawaza S, Iwai T . Randomized controlled exploratory study comparing the usefulness of two types of metallic stents with different axial forces for the management of duodenal obstruction caused by pancreatobiliary cancer. J Hepatobiliary Pancreat Sci. 2016; 23(5):289-97. DOI: 10.1002/jhbp.341. View

13.

Piesman M, Kozarek R, Brandabur J, Pleskow D, Chuttani R, Eysselein V . Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol. 2009; 104(10):2404-11. DOI: 10.1038/ajg.2009.409. View

14.

Sasaki T, Ishibashi R, Yoshida S, Fujisawa T, Shinagawa H, Gon C . Comparing the mechanical properties of a self-expandable metallic stent for colorectal obstruction: Proposed measurement method of axial force using a new measurement machine. Dig Endosc. 2020; 33(1):170-178. DOI: 10.1111/den.13671. View

15.

van Hooft J, Uitdehaag M, Bruno M, Timmer R, Siersema P, Dijkgraaf M . Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc. 2009; 69(6):1059-66. DOI: 10.1016/j.gie.2008.07.026. View

16.

Park J, Kim G, Song H, Kim M, Kim P, Kim K . Significance of Stent Abutment in Gastroduodenal Stent Placement for Gastric Outlet Obstructions. J Vasc Interv Radiol. 2017; 28(8):1147-1153. DOI: 10.1016/j.jvir.2017.01.013. View

17.

Yamao K, Kitano M, Chiba Y, Ogura T, Eguchi T, Moriyama I . Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction. Gut. 2020; 70(7):1244-1252. PMC: 8223634. DOI: 10.1136/gutjnl-2020-320775. View

18.

van Halsema E, Rauws E, Fockens P, van Hooft J . Self-expandable metal stents for malignant gastric outlet obstruction: A pooled analysis of prospective literature. World J Gastroenterol. 2015; 21(43):12468-81. PMC: 4649130. DOI: 10.3748/wjg.v21.i43.12468. View