title: Gastroduodenal stenting with Niti-S stent: long-term benefits and additional stent intervention.
abstract: OBJECTIVE
  Self-expandable metallic stents have mainly been used for the palliation of malignant gastric outlet obstruction (GOO). However, their use in long-term survivors and the feasibility, safety and benefit of additional intervention for stent dysfunction remain controversial. The present study examined the long-term benefits of endoscopic gastroduodenal stenting.
  
  
  METHODS
  We reviewed 61 patients treated with Niti-S stents at several hospitals and estimated the efficacy of stent intervention, stent patency, eating period and factors related to poor effectiveness.
  
  
  RESULTS
  All 61 first stent interventions and 14 additional stent interventions (11 second interventions and 3 third interventions) were successfully carried out. Clinical success rates were 83.6% and 85.7%, and median stent patency was 214 days and 146 days (P = 0.47), respectively. Fifty patients could be treated with a first stent only, and 11 patients received additional stents. At the time of study termination or death, 70.0% of the former group and 63.6% of the latter group maintained oral intake (P = 0.71), and each 86% and 100% among the group could maintain oral intake for a period exceeding half of their remaining lives after first stent intervention. Karnofsky performance status ≤50 (P = 0.03), ascites (P = 0.009), and peritoneal dissemination (P = 0.001) appeared to be factors related to poor effectiveness.
  
  
  CONCLUSIONS
  Despite the presence of factors related to poor effectiveness, endoscopic gastroduodenal stenting would be the first treatment of choice for GOO and provide long-term benefits. If stent dysfunction occurs, additional stent intervention enables continued oral intake safely.
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan; Division of Gastroenterology, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishihara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004386:Duodenum / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000150:complications* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Niti-S gastroduodenal stenting; additional stent intervention; factors related to poor effectiveness; gastric outlet obstruction (GOO); long-term benefit