Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study.
BACKGROUND
Self-expandable metallic stents (SEMSs) provide effective palliation of malignant pyloric obstruction in patients with inoperable gastric cancer.


OBJECTIVE
To compare the effectiveness and side effects of covered and uncovered SEMSs for the palliation of malignant pyloric obstruction.


METHODS
Prospective, randomized, single-center study.


METHODS
Tertiary-care cancer center hospital.


METHODS
This study involved 80 patients with pyloric obstruction related to inoperable gastric cancer.


METHODS
Covered or uncovered SEMS placement.


METHODS
Technical and clinical success rates as well as the patency rate at 8 weeks after placement.


RESULTS
Both groups had a technical success rate of 100% with no immediate complications. Both groups also had comparable clinical success rates (covered SEMS, 95% [38 of 40] and uncovered SEMS, 90% [36 of 40], P = .68) and 8-week patency rates (covered SEMS, 61.3% [19 of 31] and uncovered SEMS, 61.1% [22 of 36], P > .99). Stent migration within 8 weeks was more common in the covered SEMS group (25.8% [8 of 31]) than in the uncovered SEMS group (2.8% [1 of 36], P = .009), whereas re-stenosis because of tumor ingrowth was more common in the uncovered SEMS group (25.0% [9 of 36] vs 0% [0 of 31] in the covered SEMS group, P = .003). Overall patient survival and stent patency did not differ between groups (P = .27 and 0.61 by log-rank test, respectively).


CONCLUSIONS
The study population was limited to gastric cancer patients, and stent designs were changed in the midst of the study period.


CONCLUSIONS
Both the covered and uncovered SEMSs are effective and have comparable 8-week patency in patients with malignant pyloric obstruction, despite different patterns of late stent failure.
Kim
Chan Gyoo
CG
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Choi
Il Ju
IJ
Lee
Jong Yeul
JY
Cho
Soo-Jeong
SJ
Park
Sook Ryun
SR
Lee
Jun Ho
JH
Ryu
Keun Won
KW
Kim
Young-Woo
YW
Park
Young Iee
YI
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011446:Prospective Studies; D011707:Pyloric Stenosis / Q000628:therapy*; D012008:Recurrence; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*
D020099:Coated Materials, Biocompatible