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Malignant Gastroduodenal Obstructions: Treatment by Means of a Covered Expandable Metallic Stent-Initial Experience¹

¹ From the Departments of Diagnostic Radiology (G.S.J., J.D.H., Y.D.C.) and Internal Medicine (S.J.P., J.Y.K.), College of Medicine, Kosin University, Pusan, South Korea, and the Department of Diagnostic Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Poongnap-Dong, Songpa-Ku, Seoul 138-736, South Korea (H.Y.S., S.G.K.). Received July 22, 1999; revision requested September 24; revision received November 23; accepted December 7. G.S.J., H.Y.S., and S.G.K. supported by grant HMP-98-G-2-043 of the Highly Advanced National Project, Ministry of Health and Welfare, Republic of Korea. Address correspondence to H.Y.S. (e-mail: hysong@www.amc.seoul.kr).

PURPOSE: To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions.

MATERIALS AND METHODS: The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable.

RESULTS: Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1–4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results.

CONCLUSION: Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.

Index terms: Duodenum, stenosis or obstruction, 73.256, 73.33 • Endoscopy, 72.1229, 73.1229 • Gastrointestinal tract, interventional procedures, 72.1229, 73.1229 • Stents and prostheses, 72.1229, 73.1229 • Stomach, stenosis or obstruction, 72.256

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