title: An integrated, self-expanding, Y-shaped, metallic stent for patients with complex obstruction after gastrojejunostomy (Billroth II): initial experience.
abstract: OBJECTIVE
  This paper reports our initial experience with an integrated, self-expandable, Y-shaped, metallic stent (SEMS) for patients with complex anastomotic obstructions after gastrojejunostomy (Billroth II).
  
  
  METHODS
  Eight consecutive patients with complex anastomotic obstructions involving the afferent and efferent loops after gastrojejunostomy (Billroth II) were treated with an integrated Y-shaped SEMS. The stents were placed in the anastomosis under fluoroscopy. Technical and clinical success; complications, including recurrent obstruction and stent migration; reintervention; and survival were assessed during follow-up.
  
  
  RESULTS
  Y-shaped SEMS placement in the anastomotic areas was technically successful and well tolerated in all patients, with no procedure-related complications. Clinical success was observed in all patients 1-7 days after the procedure. The improvement between pre- and postoperative gastric outlet obstruction scoring system (GOOSS) was statistically significant (p=0.01). During follow-up for 3.13 ± 1.81 months, all stenoses were resolved without stent-related complications, and general physical examination of the eight patents showed improvement. Five patients continued with follow-up health care after the procedures; the remaining three died of causes unrelated to stent insertion. The mean and median survival periods were 3.92 ± 0.81 months [95% confidence interval (CI) 2.34-5.50] and 3.0 ± 0.64 months (95% CI 1.74-4.26), respectively.
  
  
  CONCLUSIONS
  Deployment of an integrated Y-shaped SEMS proved to be an expedient, simple, safe and minimally invasive procedure for treating complex anastomotic stenoses after gastrojejunostomy (Billroth II).
authors.affiliation: Department of Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, Henan Province, PR China.
authors.forename: G
authors.initials: G
authors.lastname: Wu
authors.forename: Y-D
authors.initials: YD
authors.lastname: Li
authors.forename: X-W
authors.initials: XW
authors.lastname: Han
authors.forename: P-X
authors.initials: PX
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D015390:Gastric Bypass / Q000295:instrumentation*; D017219:Gastric Outlet Obstruction / Q000628:therapy*; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008670:Metals; D008875:Middle Aged; D015641:Radiography, Interventional; D012086:Reoperation; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D008670:Metals; D007472:Iohexol; C038192:iopromide