Self-expandable metal stents for recurrent malignant obstruction after gastric surgery

Abstract

BACKGROUND/AIMS: It is well known that endoscopic insertion of self-expandable metallic stents (SEMS) is safe and effective for the palliative treatment of malignant strictures involving the upper gastrointestinal tract. But, most previous studies focused on stent insertion for esophageal or gastroduodenal obstructions. Only a few cases of stent insertion for recurrent malignant obstruction after gastric cancer surgery have been reported in studies in fewer than 40 patients. The aim of this study was to evaluate the clinical effectiveness of the placement of SEMS in patients with anastomotic recurrence after gastric cancer surgery and compare the clinical outcome according to stent and operation type.

METHODOLOGY: The data were collected from 47 patients in whom SEMS were placed by endoscopic approach for recurrent malignant obstruction after gastric cancer surgery. Technical and clinical success and complications according to operation and stent type were evaluated. Also, Overall survival and stent patency rates were calculated.

RESULTS: Stent placement was technically successful in 45 of the 47 patients (95.7%). After stent placement, 91.5% of the patients showed improvement in their dietary intake level. A statistically significant improvement in overall Gastric Outlet Obstruction Scoring System between pre- and postprocedure was noted (p<0.001). Stent failure occurred in 13 patients (stent migration: 4; tumor overgrowth: 1; tumor ingrowth: 8). The median survival and stent patency period were 101 days and 63 days, respectively.

CONCLUSIONS: SEMS insertion in patients with anastomotic recurrence of gastric cancer after gastric cancer surgery is technically feasible and clinically effective.