title: Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of secondary gastroduodenal stent placement after first stent dysfunction for malignant gastric outlet obstruction.
  
  
  METHODS
  We conducted a retrospective analysis to investigate the efficacy and safety of secondary stent-in-stent gastroduodenal stent placement.
  
  
  RESULTS
  Among 260 patients who had been treated with first gastroduodenal stent placement for malignant gastric outlet obstruction, 29 patients (11.2%) were treated with secondary gastroduodenal stent placement because of first stent dysfunction. Pancreatic cancer was the major primary cancer (55.2%). A WallFlex duodenal stent was the most frequently inserted stent both as a first stent (75.9%) and as a secondary stent (62.1%). There were 22 patients (75.9%) that received gastroduodenal stents at the bending site (supraduodenal angle or infraduodenal angle). Technical and clinical success rates were 100% and 86.2%, respectively. Median eating period was 3.0 months, and median survival time was 3.5 months. As for related complications, gastrointestinal perforation, insufficient stent expansion, tumor ingrowth, tumor overgrowth, and cholangitis were experienced in 13.8% (four cases), 6.9% (two cases), 6.9% (two cases), 3.4% (one case), and 3.4% (one case), respectively.
  
  
  CONCLUSIONS
  Secondary gastroduodenal stent placement might be effective for managing first stent dysfunction in malignant gastric outlet obstruction. However, gastrointestinal perforation was the major complication.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Naminatsu
authors.initials: N
authors.lastname: Takahara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Dai
authors.initials: D
authors.lastname: Mohri
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Saburo
authors.initials: S
authors.lastname: Matsubara
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D005471:Fluoroscopy; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005770:Gastrointestinal Neoplasms / Q000150:complications*; D006801:Humans; D010166:Palliative Care / Q000379:methods; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: axial force; gastric outlet obstruction; gastrointestinal perforation; re-intervention; stent-in-stent