Predictors of the patency of self-expandable metallic stents in malignant gastroduodenal obstruction.
OBJECTIVE
To investigate the predictive factors of self-expandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction.


METHODS
A total of 116 patients underwent stent placements for inoperable malignant gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization's scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency.


RESULTS
Self-expandable metallic stent placement was technically successful in all patients (100%), and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model, carcinoembryonic antigen (CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio (aHR) = 2.92, 95%CI: 1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency (P = 0.009; aHR = 0.27, 95%CI: 0.10-0.72).


CONCLUSIONS
CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Seung Han
SH
Kim
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Hoon Jai
HJ
Chun
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
In Kyung
IK
Yoo
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Jae Min
JM
Lee
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Seung Joo
SJ
Nam
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Hyuk Soon
HS
Choi
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Eun Sun
ES
Kim
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Bora
B
Keum
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Yeon Seok
YS
Seo
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Yoon Tae
YT
Jeen
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Hong Sik
HS
Lee
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Soon Ho
SH
Um
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
Chang Duck
CD
Kim
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002272:Carcinoembryonic Antigen / Q000097:blood; D004380:Duodenal Obstruction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D016896:Treatment Outcome
D002272:Carcinoembryonic Antigen; D008670:Metals
Carcinoembryonic antigen; Malignant gastroduodenal obstruction; Patency; Predictive factor; Stent