Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer.

Abstract

AIM:

To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a self-expandable metal stent (SEMS) for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer.

METHODS:

The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary's Hospital, were reviewed retrospectively.

RESULTS:

Twenty patients (15 male, mean age 63 years) were included. The operations were a total gastrectomy with esophagojejunostomy (n = 12), subtotal gastrectomy with Billroth-I reconstruction (n = 2) and subtotal gastrectomy with Billroth-II reconstruction (n = 8). The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients (15%) within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-II reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d (range, 5-439 d). The median survival was 83 d (range, 12-439 d).

CONCLUSION:

Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer. A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

• Authors: Yu Kyung Cho, Sang Woo Kim, Kwan Woo Nam, Jae Hyuck Chang, Jae Myung Park, Jeong-Jo Jeong, In Seok Lee, Myung-Gyu Choi, In-Sik Chung
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 15 Issue 28 Pg. 3523-7 (Jul 28 2009) ISSN: 2219-2840 [Electronic] United States
• PMID: 19630108 (Publication Type: Evaluation Study, Journal Article)

Topics

• Aged
• Constriction, Pathologic (etiology, pathology, surgery)
• Endoscopy (methods)
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (complications, pathology, surgery)
• Stents
• Stomach Neoplasms (complications, pathology, surgery)
• Survival Rate
• Treatment Outcome