title: Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents.
abstract: BACKGROUND
  Uncovered, rather than covered, metal stents are commonly used for palliation of malignant gastric outlet obstruction because of the low risk of stent migration, but tumor ingrowth risk is a major drawback. Few reports address malignant obstruction after gastric surgery.
  
  
  OBJECTIVE
  Our purpose was to compare the technical feasibility and clinical outcome of using an endoscopic uncovered self-expandable metal stent (SEMS) and simultaneous use of uncovered and covered SEMS (double SEMS) in patients with recurrent malignant obstruction after gastric surgery.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary care, academic medical center, from August 2000 to June 2005.
  
  
  METHODS
  Twenty patients were included in the study. All patients had symptomatic obstruction with nausea, vomiting, and decreased oral intake.
  
  
  METHODS
  Ten patients received uncovered SEMS; the other 10 received double SEMS.
  
  
  METHODS
  To compare tumor ingrowth and stent patency between the uncovered and the double-SEMS groups.
  
  
  RESULTS
  Technical and clinical successes were 10 of 10 and 8 of 10, respectively, in the uncovered SEMS group and 10 of 10 and 10 of 10, respectively, in the double SEMS group. Six of 10 patients (60%) with uncovered SEMS had tumor ingrowth compared with 1 of 10 patients with double SEMS, P = .057. Five of 10 patients (50%) with uncovered SEMS had very early restenosis, but no patients had early restenosis in the double SEMS group, P = .033. Stent patency was a median of 21.5 days (range, 7-217 days) in the uncovered SEMS group and 150 days (range 29-263 days) in the double SEMS group, P = .037. Survival duration was 109.5 days (range 29-280 days) and 150 days (range 29-263 days), respectively.
  
  
  CONCLUSIONS
  This was a small retrospective study.
  
  
  CONCLUSIONS
  Simultaneous double stent placement seems to be technically feasible and effective for palliative treatment of recurrent malignant obstruction after gastric surgery. Double stent placement is important in preventing tumor ingrowth, especially very early restenosis, and prolongs stent patency. We suggest that this procedure be considered rather than uncovered stent alone as the primary choice for palliation of obstruction in such patients.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Pusan National University College of Medicine, Busan, Korea.
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Tae Oh
authors.initials: TO
authors.lastname: Kim
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Heo
authors.forename: Jeong Yeol
authors.initials: JY
authors.lastname: Kim
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Lee
authors.forename: Yeol Jo
authors.initials: YJ
authors.lastname: Jeoung
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Jeon
authors.forename: Dong Heon
authors.initials: DH
authors.lastname: Kim
authors.forename: Mun Sup
authors.initials: MS
authors.lastname: Sim
mesh_terms: D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome