Effectiveness of self-expanding metal stents for malignant antropyloric and duodenal obstruction with a comparison between covered and uncovered stents

Abstract

BACKGROUND/AIMS: We evaluated overall clinical outcomes when self-expanding metal stents were used to treat malignant gastroduodenal obstruction; we also evaluated the differences in technical feasibility, effectiveness, and outcomes between covered and uncovered stents.

METHODOLOGY: We reviewed 134 patients who underwent endoscopic treatment for malignant antropyloric and duodenal obstructions with self-expanding metal stents.

RESULTS: In all but two cases, the procedures were successful in restoring passage through the obstruction. Forty-two patients (31.8%) experienced stent failure during the follow-up period (23/79 (29.1%) with uncovered stents, 19/53 (35.8%) with covered stents). Stent migration was the most common cause for failure in covered stents (73.7%), while tumor ingrowth was the most common cause in uncovered stents (52.2%). The median technical survival in the uncovered stent group was similar to covered stent group (253 days vs. 247 days, p>0.05). Improvement of oral intake was associated with improvement in performance score, which was significantly improved following stent insertion (p<0.05). In addition, patients whose performance score was improved by stenting had better survival than those who did not (median survival 173 days vs. 74 days, p<0.05).

CONCLUSIONS: Endoscopic stenting for malignant gastroduodenal obstruction appears to be an effective therapeutic modality in terminally ill patients, irrespective of the type of stent. Improvement in stent technology will improve patients' oral intake, which in turn will improve patients' quality of life and survival rate.