Self-expandable metallic stent placement for malignant obstruction in patients with locally recurrent gastric cancer.
BACKGROUND
Self-expandable metallic stents (SEMSs) provide effective palliation for inoperable malignant gastric outlet obstruction (GOO). The objective of this study was to evaluate the effectiveness of SEMSs in patients with recurrent gastric cancer after radical gastrectomy.


METHODS
We retrospectively analyzed data from patients with gastric cancer who underwent endoscopic SEMS placement. The patients had obstructive symptoms due to recurrent gastric cancer after curative-intent subtotal or total gastrectomies. Technical and clinical success rates of stent placement were evaluated and clinical outcomes were compared according to operation types.


RESULTS
A total of 15 patients underwent total gastrectomies with esophagojejunostomies and Roux-en-Y reconstructions, 8 underwent subtotal gastrectomies with Billroth I reconstructions, and 12 underwent subtotal gastrectomies with Billroth II reconstructions. Four patients in the Billroth II group received stents in afferent and efferent loops, so a total of 39 stents were placed. Technical success was achieved with 92% (36/39) of stents, and clinical success occurred with 90% (35/39) of stents, with no significant differences among surgery groups or between stent types (covered vs. uncovered). The GOO score (preprocedure: 0.45±0.62) increased by 1 week (2.06±0.51, p<0.001) and was maintained up to 1 month (1.71±1.15, p<0.001 compared with initial score). Complications occurred with 17 of 39 stents (44%) and included 2 perforations, 3 migrations, and 12 restenoses. Median stent patency duration was 10.7 weeks and median survival was 21.3 weeks; these did not significantly differ by surgery group (p=0.25 and 0.93, respectively) or stent type (covered vs. uncovered, p=0.51 and 0.96, respectively).


CONCLUSIONS
Endoscopic SEMS placement for obstruction due to recurrent cancer after total or subtotal gastrectomy is feasible and provides effective short-term palliation, independent of the type of surgical procedure or stent (covered vs. uncovered) used.
Kim
Jaihwan
J
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Choi
Il Ju
IJ
Kim
Chan Gyoo
CG
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 / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate