title: Outcomes of second self-expandable metallic stent insertion for malignant gastric outlet obstruction.
abstract: BACKGROUND
  Self-expandable metallic stents are used widely to relieve malignant gastric outlet obstruction (GOO). However, restenosis or migration of first stents is a frequent complication. The purpose of this retrospective cohort study was to evaluate the effectiveness of second stents as an approach to manage failure of first stents in patients with malignant GOO.
  
  
  METHODS
  A total of 222 patients with gastric cancer received first stents due to inoperable GOO at National Cancer Center in Korea between January 2008 and June 2011. Monthly follow-up interviews were performed, and second stents (stent-in-stent or stent-after-migration) were inserted in 59 patients by June 2012. Technical and clinical successes and long-term complications were evaluated.
  
  
  RESULTS
  The technical and immediate clinical success rates were 98.3 % (58/59) and 91.5 % (54/59), respectively. Patients who received a second stent due to late complications involving the first stent (migration, restenosis, and fracture) showed a higher clinical success rate (95.8 % [46/48]) than patients who received a second stent due to immediate clinical failure of the first stent (72.7 % [8/11], p = 0.04). The immediate clinical success rate of stent-after-migration (100 % [11/11]) was not different from that of stent-in-stent (89.6 % [43/48], p = 1.0). The stent dysfunction rate of stent-after-migration (27.3 % [3/11]) also was similar to that of stent-in-stent (29.2 % [14/48], p = 1.0). The median patencies of stent-in-stent and stent-after-migration were 27.4 and 58.4 weeks, respectively (p = 0.177). There were no significant prognostic factors for patency of second stents.
  
  
  CONCLUSIONS
  Insertion of a second stent is effective for treating the first-stent failure in gastric cancer patients with GOO, especially if the immediate outcome of the first stent was successful.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 410-769, Republic of Korea.
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Mi-Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Sook Ryun
authors.initials: SR
authors.lastname: Park
authors.forename: Young Lee
authors.initials: YL
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D017219:Gastric Outlet Obstruction / Q000145:classification / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology; D016896:Treatment Outcome
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