title: Application of Y-shaped, coated self-expandable metallic stents for anastomotic stenosis after gastrojejunostomy (Billroth II).
abstract: BACKGROUND
  Anastomotic stenosis is an infrequent but life-threatening complication after gastrojejunostomy (Billroth II). Tubular or single tubular stents have limited efficacy due to the particular anatomy.
  
  
  OBJECTIVE
  To assess the feasibility of a Y-shaped, fully-coated, self-expandable, metallic stent (SEMS) for anastomotic stenosis after gastrojejunostomy (Billroth II).
  
  
  METHODS
  Between January 2008 and August 2014, 14 patients (10 with gastric carcinoma and four with duodenal ulcers) had anastomotic stenoses following Billroth II reconstructions. Eight patients with gastric cancer had tumor recurrence near the anastomosis; two had benign strictures. The four duodenal ulcer patients had benign stenoses. An integrated Y-shaped, fully coated SEMS was designed to accord with the anatomy of residual gastrojejunal anastomotic strictures. Fourteen stents were inserted under fluoroscopic control. Follow-up was at 1, 3, 9, and 12 months, and then annually.
  
  
  RESULTS
  All 14 stents were inserted successfully at the first attempt with a technical success rate of 100%. After stenting, abdominal symptoms resolved in all patients. All patients were followed up for 4-27 months (mean, 13.9 months). One of the eight recurrent cases died of multiple tumor metastases and liver failure after 7 months, without obstruction symptoms. In all six patients with benign anastomotic stenosis, the stents were removed successfully without complication and with no evidence of restenosis based on clinical evaluation and imaging.
  
  
  CONCLUSIONS
  A Y-shaped, fully-coated SEMS proved to be a feasible and minimally invasive procedure for treating anastomotic stenosis after gastrojejunostomy (Billroth II).
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Teng-Fei
authors.initials: TF
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China hanxinwei2006@163.com.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Han
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Shao-Feng
authors.initials: SF
authors.lastname: Shui
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Jian-Zhuang
authors.initials: JZ
authors.lastname: Ren
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.|Interventional Institute of Zhengzhou University, Zhengzhou, PR China.|Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China.
authors.forename: Ke-Wei
authors.initials: KW
authors.lastname: Ren
mesh_terms: D000328:Adult; D000368:Aged; D020099:Coated Materials, Biocompatible; D055119:Elastic Modulus; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible
keywords: Billroth II resection; Stomach; anastomotic stenosis; jejunum; stent