title: Clinical outcomes of re-stenting in patients with stent malfunction in malignant gastric outlet obstruction.
abstract: OBJECTIVE
  Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastric outlet obstruction (GOO). The aim of this study was to evaluate the clinical outcomes of salvage SEMS for stent malfunction and to identify the prognostic factors for a longer patency.
  
  
  METHODS
  A total of 108 patients who underwent a secondary salvage SEMS placement for a primary stent malfunction were retrospectively reviewed at the Seoul National University Hospital between August 2004 and May 2013. The duration of patency for salvage SEMS was defined as the time between salvage SEMS placement and the recurrence of obstructive symptoms that were confirmed either endoscopically or radiologically.
  
  
  RESULTS
  The technical and clinical success rates for salvage SEMS were 100 and 82.4% (95% confidence interval [CI] 74.0-89.0), respectively. A salvage SEMS malfunction occurred in 29 (26.9%) of the 108 patients. The median duration of patency for salvage SEMS was 59.5 days (range 3-928, 95% CI 73.7-118.3). Longer SEMS patencies of more than 60 days were significantly associated with palliative chemotherapy (odds ratio = 2.539, 95% CI 1.031-6.252, p = .043). For salvage SEMS, covered-uncovered stents had a longer patency duration, as compared with other combinations of primary and salvage stent types.
  
  
  CONCLUSIONS
  Longer patency durations for salvage SEMS were associated with palliative chemotherapy after salvage SEMS insertion. Salvage SEMS could be a feasible and effective treatment for primary stent malfunction in malignant GOO.
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eun Hyo
authors.initials: EH
authors.lastname: Jin
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-799, Korea. harley1333@hanmail.net.
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-799, Korea.
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-799, Korea.
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 110-799, Korea.
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000150:complications* / Q000601:surgery; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Gastric outlet obstruction; Patency; Salvage; Self-expanding metal stent