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Malignant Obstruction of Gastric Outlet and Duodenum: Palliation with Flexible Covered Metallic Stents¹

¹ From the Department of Radiology (K.B.P., Y.S.D., S.W.C., Y.H.H., S.J.L., I.W.C.), Division of Hematology/Oncology, Department of Medicine (W.K.K.), and Department of Medical Engineering (S.W.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, 135-710, Korea; and the Department of Radiology, Chung Buk National University Hospital, Cheungju, Korea (K.S.P.). Received June 13, 2000; revision requested July 24; revision received October 12; accepted October 18. 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 Y.S.D. (e-mail: ysdo@smc.samsung.co.kr).

PURPOSE: To assess the usefulness of flexible covered metallic stents in the palliation of malignant obstruction of the gastric outlet and duodenum.

MATERIALS AND METHODS: Twenty-four consecutive patients with malignant obstruction of the gastric outlet (n = 22) or duodenum (n = 2) underwent palliative treatment with self-expandable flexible covered metallic stents. Fourteen patients had advanced gastric carcinoma at the antrum and/or pylorus, and eight had obstruction at the anastomosis site of previous gastrojejunostomy. Complications and clinical status were investigated during the study period.

RESULTS: The technical success rate was 75% (18 of 24 patients). Twenty-one stents were placed in 18 patients by using an introducer 6 (n = 7) or 8 mm (n = 14) in diameter. The mean follow-up period was 3.4 months (range, 1 week to 9 months). Symptoms improved in 12 (67%) patients after the procedure. There was no change in symptoms in five and a decrease in one. Twelve patients died during the follow-up period (mean survival, 4.3 months). The complication rate was 25% (six of 24 patients), including stent migration (n = 5) and fracture (n = 3).

CONCLUSION: Flexible covered metallic stent placement can be useful for palliation in patients with malignant obstruction of the gastric outlet or duodenum.

Index terms: Duodenum, stenosis or obstruction, 73.1432 • Gastrointestinal tract, interventional procedures, 72.1269, 73.1269 • Stents and prostheses, 72.1269, 73.1269 • Stomach, neoplasms, 72.30 • Stomach, stenosis or obstruction, 72.1432

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