title: Uncovered self-expandable metallic stent placement as a first-line palliative therapy in unresectable malignant duodenal obstruction.
abstract: OBJECTIVE
  To report treatment outcomes and complications of uncovered self-expandable metallic stents (SEMS) as a first-line therapy for inoperable malignant duodenal obstructions in our hospital.
  
  
  METHODS
  A retrospective analysis was performed in patients who had undergone placement of uncovered SEMS as a first-line therapy for inoperable malignant duodenal obstruction from August 2001 to July 2011. Treatment outcomes and complications of the procedures were investigated.
  
  
  RESULTS
  In total, 47 patients (25 men; mean age 65 years) underwent the procedure. The technical and clinical success rates were 93.6% and 83.0%, respectively. Early complications occurred in 8 patients, including two guidewire-induced micro-perforations and six pancreatitis. All these 8 patients recovered with conservative treatment. Six late complications requiring additional procedures consisted of five stent occlusions due to tumor ingrowth and one stent migration. Four stent occlusions and one migration were treated by the placement of an additional covered stent and the remaining case was treated by balloon dilatation. The median primary stent patency period and median survival period after primary stent placement were 103 days and 131 days, respectively.
  
  
  CONCLUSIONS
  Uncovered SEMS placement is effective as a first-line palliative therapy for inoperable malignant duodenal obstruction. Complications such as stent occlusion or migration can be easily managed with additional covered SEMS.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Hyung Su
authors.initials: HS
authors.lastname: Ahn
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Bong Min
authors.initials: BM
authors.lastname: Ko
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Myung Soo
authors.initials: MS
authors.lastname: Kang
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*
chemical_list: D008670:Metals