title: Clinical outcomes of secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction.
abstract: BACKGROUND
  Although a substantial number of patients require secondary stents insertion due to primary stent malfunction in malignant gastric outlet obstruction, data on the outcomes of secondary self-expanding metal stents are sparse.
  
  
  OBJECTIVE
  To investigate clinical outcomes and factors related with secondary stent malfunction in patients with malignant gastric outlet obstruction given secondary stent-in-stent self-expanding metal stent insertion.
  
  
  METHODS
  For this retrospective study, a total 77 patients who underwent secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction were enrolled. We compared the effectiveness and complications of secondary covered and uncovered stents and explored the predictive factors for stent malfunction.
  
  
  RESULTS
  Stent-in-stent self-expanding metal stent placements were technically successful in all patients. Both groups also had comparable clinical success rates (covered stent, 87.2% and uncovered stent, 90.0%, P = 1.000). Stent malfunction rates (31.9% and 36.7% respectively, P = 0.805) and median patency time of stent (165 [95% confidence interval: 112-218] and 165 [95% confidence interval: 126-204] days, respectively, P = 0.358) were similar between secondary covered and uncovered stents. Longer patients' survival time (≥ 100 days) was associated with increased risk of stent malfunction (odds ratio: 4.598; 95% confidence interval: 1.473-14.355; P = 0.009).
  
  
  CONCLUSIONS
  Secondary stent-in-stent self-expanding metal stent placement is feasible and effective treatment for primary stent malfunctions in malignant gastric outlet obstruction. Covered and uncovered stent are equally acceptable in terms of stent-related complications and stent patency, regardless of primary stent type.
authors: Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors: Jun Chul
authors: JC
authors: Park
authors: Jae Jun
authors: JJ
authors: Park
authors: Kungseok
authors: K
authors: Cheoi
authors: Hyunsoo
authors: H
authors: Chung
authors: Hyuk
authors: H
authors: Lee
authors: Sung Kwan
authors: SK
authors: Shin
authors: Sang Kil
authors: SK
authors: Lee
authors: Yong Chan
authors: YC
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000150:complications* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome