Metallic Stent Expansion Rate at Day One Predicts Stent Patency in Patients with Gastric Outlet Obstruction.
Self-expandable metallic stent insertion has been a mainstream treatment for relieving the obstructive symptoms of malignant gastric outlet obstruction (MGOO), a late-stage complication of gastrointestinal malignancies. This study aims to investigate the predictive value of stent expansion rates in clinical outcomes in patients with MGOO.



Eighty-seven patients with inoperable MGOO receiving metallic stents were reviewed retrospectively from April 2010 to December 2014. Clinical outcomes, predictors of stent patency, and survival were analyzed.



The technical and clinical success rates were 100 and 94.3%, respectively. The median stent patency time was 114 days (range 13-570 days). The median survival time was 133 days (range 13-1145 days). Stent dysfunctions occurred in 28 patients (32.2%), with restenosis accounting for the majority (82%). The stent expansion rate ≥75% at Day 1 predicted the stent patency [hazard ratio (HR) 0.12, P = 0.04]. However, it did not correlate with survival. Non-gastric cancer origins (HR 2.41, P = 0.002) and peritoneal carcinomatosis (HR 2.54, P = 0.001) correlated with poor survival. However, post-stent chemotherapy (HR 0.55, P = 0.03) was related to better outcome. The comparison of clinical outcomes of first and second stent insertions showed no significant difference in the stent expansion rate either at Day 0 and Day 1 (P = 0.97 and P = 0.57).



Self-expandable metallic stent insertion is a safe and effective treatment for relieving the obstructive symptoms. The stent expansion rate ≥75% at Day 1 is a novel stent-related predictor of stent patency.
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan.
Bing-Wei
BW
Ye
Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, National Yang-Ming University Hospital, Ilan, Taiwan.
Chung-Kai
CK
Chou
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yun-Cheng
YC
Hsieh
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Chung-Pin
CP
Li
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yee
Y
Chao
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Endoscopic Diagnosis and Therapeutic Center, Taipei Veterans General Hospital, Taipei, Taiwan.
Ming-Chih
MC
Hou
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Han-Chieh
HC
Lin
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. kclee2@vghtpe.gov.tw.|Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. kclee2@vghtpe.gov.tw.
Kuei-Chuan
KC
Lee
D000008:Abdominal Neoplasms / Q000150:complications / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011183:Postoperative Complications; D015607:Stents
Malignant gastric outlet obstruction; Self-expandable metallic stent; Stent expansion rate; Stent patency; Stent-related predictor