title: Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer.
abstract: 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.
authors.affiliation: 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.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Kwan Woo
authors.initials: KW
authors.lastname: Nam
authors.forename: Jae  Hyuck
authors.initials: J
authors.lastname: Chang
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Jeong-Jo
authors.initials: JJ
authors.lastname: Jeong
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
authors.forename: In-Sik
authors.initials: IS
authors.lastname: Chung
mesh_terms: 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