Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer.
OBJECTIVE
To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a self-expandable metal stent (SEMS) for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer.


METHODS
The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary's Hospital, were reviewed retrospectively.


RESULTS
Twenty patients (15 male, mean age 63 years) were included. The operations were a total gastrectomy with esophagojejunostomy (n = 12), subtotal gastrectomy with Billroth-I reconstruction (n = 2) and subtotal gastrectomy with Billroth-II reconstruction (n = 8). The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients (15%) within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-II reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d (range, 5-439 d). The median survival was 83 d (range, 12-439 d).


CONCLUSIONS
Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer. A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.
Cho
Yu Kyung
YK
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 505 Banpodong, Seochogu, Seoul 137-040, South Korea.
Kim
Sang Woo
SW
Nam
Kwan Woo
KW
Chang
Jae  Hyuck
J
Park
Jae Myung
JM
Jeong
Jeong-Jo
JJ
Lee
In Seok
IS
Choi
Myung-Gyu
MG
Chung
In-Sik
IS
D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology / Q000601:surgery; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome