[Use of partially covered nitinol stents in malignant gastroduodenal obstructions].
OBJECTIVE
To demonstrate our experience with self-expanding nitinol duodenal stents in the treatment of inoperable malignant gastroduodenal obstructions.


METHODS
Seventy two (72) patients with malignant gastroduodenal obstruction, 42 men and 30 women, were treated with peroral application of a gastroduodenal nitinol stent. The average age was 61.3 years (range of 21 to 92 years). The gastroduodenal obstructions was caused by gastric tumors (38 patients), pancreatic tumors (15), gallbladder tumors (8), bile duct tumors (5), metastatic tumors (4) and two cases of duodenal invasion by regional tumor (colon and hypernephroma). These conditions were considered inoperable in all the patients. Using a flexible 20 Fr. intubator and assisted by endoscopy and fluoroscopy, 3 uncovered stents, 7 fully covered stents and 62 partially covered stents were inserted.


RESULTS
A stent was inserted in 67 of the 72 patients (93%) and no patient showed any duodenal perforation nor needed surgery. As to the symptoms, of the 12 patients who did not tolerate any type of oral treatment, 10 improved after the duodenal stents were introduced. Stent migration was observed in 6 cases, 4 of these with fully covered stents. In these cases, the stents were removed by endoscopy and then replaced by a partially covered stent. Tumor colonization was observed in five cases, two of them with the uncovered stents initially used. Out of the 62 procedures with partially covered stents, migration was observed in two cases and only two stents were colonized by the tumor. Patients died between 1 and 96 weeks after introducing the stents (average survival was 20.7 weeks).


CONCLUSIONS
Peroral placement of nitinol stents is an effective and easy method of mitigation for most patients with malignant gastro-duodenal obstructions. Migration of fully covered stents and tumor colonization of uncovered stents are important limitations, which can be avoided by using partially covered stents.
Castaño Llano
Rodrigo
R
Cirugía Gastrointestinal y Endoscopia, Hospital Pablo Tobón Uribe, Universidad de Antioquia. rcastanoll@une.net.co
Alvarez Barrera
Oscar
O
Lopera
Jorge
J
Ruiz Vélez
Mario H
MH
Juliao Baños
Fabian
F
Sanín Fonnegra
Eugenio
E
Erebrie
Faruk
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys / Q000627:therapeutic use*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000379:methods; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
D000497:Alloys; D020099:Coated Materials, Biocompatible; C013616:nitinol