title: Metallic stent placement in patients with recurrent malignant obstruction in the surgically altered stomach.
abstract: OBJECTIVE
  The purpose of this study was to assess the technical feasibility and clinical effectiveness of expandable metallic stent placement in 196 patients with recurrent malignant obstruction in their surgically altered stomach.
  
  
  METHODS
  The 196 patients were treated using five different types of gastric surgery performed for gastric cancer: total gastrectomy (type 1) in 73 patients; distal gastrectomy with gastroduodenostomy (type 2) in 39 patients; distal gastrectomy with a Roux-en-Y gastrojejunostomy (type 3) in 21 patients; distal gastrectomy with a gastrojejunostomy (type 4) in 49 patients; and palliative gastrojejunostomy for unresectable gastric cancer (type 5) in 14 patients. The technical and clinical success rates, complications, dysphagia score, and influence of chemotherapy were evaluated and the complications compared between the two stent types. The overall survival and stent patency were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Stent placement was technically successful in 192 of 196 patients (97.9 %), with 184 of the 192 patients (95.8 %) showing symptomatic improvement. The mean dysphagia score improved from 3.24 ± 0.64 to 1.48 ± 0.82 (p < 0.001). The complication rate was 25 %. The incidence of stent migration was significantly higher in fully covered stents and in patients who underwent chemotherapy (p < 0.001 and p = 0.005, respectively). Chemotherapy was significantly associated with an increase of survival (p < 0.001). The median survival and stent patency were 131 and 90 days, respectively.
  
  
  CONCLUSIONS
  Placement of expandable metallic stents in patients with recurrent cancer after a surgically altered stomach is technically feasible and clinically effective. Chemotherapy was associated with increased stent migration and prolonged survival.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D004385:Duodenostomy; D004386:Duodenum / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000150:complications*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects; D015607:Stents / Q000009:adverse effects; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate; D014839:Vomiting / Q000209:etiology