[The usefulness of clip application in preventing migration of self-expandable metal stent in patients with malignant gastrointestinal obstruction].
OBJECTIVE
Management of malignant gastrointestinal obstruction presents a significant challenge. Recently, self-expandable metal stent (SEMS) has emerged as an effective, safe, and less invasive alternative for the treatment of malignant intestinal obstruction. Accordingly, we reviewed our experience in SEMS insertion with hemoclip placement.


METHODS
Between June 2004 and December 2005, a total of 40 SEMS were tried to place in 38 patients with malignant intestinal obstruction. Two stents were placed again due to recurrent obstruction and delayed stent migration after initial stent placement. We analyzed the technical and clinical success rates and complications.


RESULTS
Total stent placement was successful in 38/40 (95%). In 2 cases, stent placement was failed due to complete obstruction. Twenty-eight stents for palliation of malignant intestinal stenosis, 9 stents for one-staged operation for malignant colonic obstruction, and 1 stent for management of tracheoesophageal fistula were placed. Stent migration occurred in 6/38 (15.8%). Early stent migration rate was significantly lower in the clipping group (0/19, 0%) than in the non-clipping group (5/19, 26.3%, p=0.04). Recurrent obstruction occurred in 2/38 (6.1%) due to tumor ingrowth and in 1/38 (2.6%) due to hard food materials.


CONCLUSIONS
Application of the clips reduce early stent migration in patients with malignant gastrointestinal obstruction.
Park
Seon Young
SY
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Park
Chang Hwan
CH
Cho
Sung Bum
SB
Lee
Jung Soo
JS
Joo
So Young
SY
Park
Hyeong Cheon
HC
Lee
Wan Sik
WS
Joo
Young Eun
YE
Kim
Hyun Soo
HS
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
Kim
Sei Jong
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000295:instrumentation; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery