title: Outcome of self-expandable metallic stent deployment in patients with malignant gastroduodenal outlet obstruction and Niti-S and WallFlex comparison: a multicenter retrospective clinical study.
abstract: OBJECTIVE
  Several studies report on the outcomes of self-expandable metallic stents (SEMSs) deployment for malignant gastric outlet obstruction (GOO). However, data was mostly based on the analysis of single-center studies including only a small number of patients. This study aimed to evaluate clinical outcomes after the deployment of SEMS in patients with malignant GOO and to compare the clinical outcomes of two metallic stents with different designs.
  
  
  METHODS
  Altogether 125 consecutive patients from five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric/duodenal and WallFlex duodenal stents was also undertaken.
  
  
  RESULTS
  Rates for clinical and technical success were 100% and 92.0%, respectively. The median stent patency and survival periods were 72.0 days (range 3-775 days) and 75.0 days (range 3-775 days), respectively. The rate of overall adverse events was 28.8%. The rate of stent dysfunction was 16.8%, and that of adverse events, except stent dysfunction was 12.0%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S stent was significantly higher than that for WallFlex stent (96.2% vs 84.8%, P = 0.023).
  
  
  CONCLUSIONS
  We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral food intake. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. katou-h@cc.okayama-u.ac.jp.|Hakushusanbi Endoscopic Workshop Group, Japan. katou-h@cc.okayama-u.ac.jp.
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.affiliation: Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan.|Hakushusanbi Endoscopic Workshop Group, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: Department of Gastroenterology, Tottori University Hospital, Yonago, Japan.|Hakushusanbi Endoscopic Workshop Group, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Division of Clinical study of Oncology, Shimane University School of Medicine, Izumo, Japan.|Hakushusanbi Endoscopic Workshop Group, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Moriyama
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.|Hakushusanbi Endoscopic Workshop Group, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamada
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.affiliation: Department of Gastroenterology and Hepatology, Tottori Municipal Hospital, Tottori, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Goto
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Fukuba
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University, Kagawa, Japan.
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sonoyama
authors.affiliation: Department of Gastroenterology, Tottori University Hospital, Yonago, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care / Q000379:methods; D011474:Prosthesis Design; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D015607:Stents; D016896:Treatment Outcome
keywords: Niti-S; WallFlex; complication; gastric outlet obstruction; self-expandable metallic stent