title: SEMS vs cSEMS in duodenal and small bowel obstruction: high risk of migration in the covered stent group.
abstract: OBJECTIVE
  To compare clinical success and complications of uncovered self-expanding metal stents (SEMS) vs covered SEMS (cSEMS) in obstruction of the small bowel.
  
  
  METHODS
  Technical success, complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed. The primary end points were rates of stent migration and overgrowth. Secondary end points were the effect of concomitant biliary drainage on migration rate and overall survival. The data was analyzed according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
  
  
  RESULTS
  Thirty-two SEMS were implanted in 20 patients. In all patients, endoscopic stent implantation was successful. Stent migration was observed in 9 of 16 cSEMS (56%) in comparison to 0/16 SEMS (0%) implantations (P = 0.002). Stent overgrowth did not significantly differ between the two stent types (SEMS: 3/16, 19%; cSEMS: 2/16, 13%). One cSEMS dislodged and had to be recovered from the jejunum by way of laparotomy. Time until migration between SEMS and cSEMS in patients with and without concomitant biliary stents did not significantly differ (HR = 1.530, 95%CI 0.731-6.306; P = 0.556). The mean follow-up was 57 ± 71 d (range: 1-275 d).
  
  
  CONCLUSIONS
  SEMS and cSEMS placement is safe in small bowel tumor obstruction. However, cSEMS is accompanied with a high rate of migration in comparison to uncovered SEMS.
authors.affiliation: Oliver Waidmann, Jörg Trojan, Mireen Friedrich-Rust, Christoph Sarrazin, Stefan Zeuzem, Jörg Gerhard Albert, Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Klinikum der Johann Wolfgang Goethe-Universität, D-60590 Frankfurt/Main, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Waidmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Trojan
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.forename: Wolf Otto
authors.initials: WO
authors.lastname: Bechstein
authors.forename: Frank
authors.initials: F
authors.lastname: Ulrich
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Jörg Gerhard
authors.initials: JG
authors.lastname: Albert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020099:Coated Materials, Biocompatible; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals
keywords: Digestive system; Endoscopy; Intestinal neoplasms; Self-expandable metal stents; Self-expandable metal stents complications; Tumor obstruction