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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).

View larger version (99K): [in a new window]   Figure 1. Photograph of (top) a polyurethane-covered nitinol stent, (middle) a sheath with inflated balloon catheter for guiding, and (bottom) a pusher catheter.

View larger version (110K): [in a new window]   Figure 2a. Patient 9. Gastric carcinoma in a 67-year-old man. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a dilated stomach because of nearly total obstruction of the pyloric portion of the stomach. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a covered stent (arrows) shows barium passage.

View larger version (100K): [in a new window]   Figure 2b. Patient 9. Gastric carcinoma in a 67-year-old man. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a dilated stomach because of nearly total obstruction of the pyloric portion of the stomach. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a covered stent (arrows) shows barium passage.

View larger version (122K): [in a new window]   Figure 3a. Patient 6. Distal common bile duct carcinoma invading the duodenum in a 56-year-old woman. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a stricture (arrow) in the second portion of the duodenum. Note the metallic biliary stent (arrowhead) placed 402 days earlier to treat jaundice. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after stent placement shows good barium passage. The stent migrated 4 days after placement. (c) Anteroposterior upper gastrointestinal radiograph shows that after placement of a second, uncovered stent (arrows), the patent lumen is reestablished. (d) Anteroposterior upper gastrointestinal radiograph obtained 64 days after placement of the second stent reveals recurrent stent stenosis (arrows) because of tumor ingrowth. (e) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a third, covered stent (arrows) shows good barium flow.

View larger version (125K): [in a new window]   Figure 3b. Patient 6. Distal common bile duct carcinoma invading the duodenum in a 56-year-old woman. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a stricture (arrow) in the second portion of the duodenum. Note the metallic biliary stent (arrowhead) placed 402 days earlier to treat jaundice. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after stent placement shows good barium passage. The stent migrated 4 days after placement. (c) Anteroposterior upper gastrointestinal radiograph shows that after placement of a second, uncovered stent (arrows), the patent lumen is reestablished. (d) Anteroposterior upper gastrointestinal radiograph obtained 64 days after placement of the second stent reveals recurrent stent stenosis (arrows) because of tumor ingrowth. (e) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a third, covered stent (arrows) shows good barium flow.

View larger version (123K): [in a new window]   Figure 3c. Patient 6. Distal common bile duct carcinoma invading the duodenum in a 56-year-old woman. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a stricture (arrow) in the second portion of the duodenum. Note the metallic biliary stent (arrowhead) placed 402 days earlier to treat jaundice. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after stent placement shows good barium passage. The stent migrated 4 days after placement. (c) Anteroposterior upper gastrointestinal radiograph shows that after placement of a second, uncovered stent (arrows), the patent lumen is reestablished. (d) Anteroposterior upper gastrointestinal radiograph obtained 64 days after placement of the second stent reveals recurrent stent stenosis (arrows) because of tumor ingrowth. (e) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a third, covered stent (arrows) shows good barium flow.

View larger version (122K): [in a new window]   Figure 3d. Patient 6. Distal common bile duct carcinoma invading the duodenum in a 56-year-old woman. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a stricture (arrow) in the second portion of the duodenum. Note the metallic biliary stent (arrowhead) placed 402 days earlier to treat jaundice. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after stent placement shows good barium passage. The stent migrated 4 days after placement. (c) Anteroposterior upper gastrointestinal radiograph shows that after placement of a second, uncovered stent (arrows), the patent lumen is reestablished. (d) Anteroposterior upper gastrointestinal radiograph obtained 64 days after placement of the second stent reveals recurrent stent stenosis (arrows) because of tumor ingrowth. (e) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a third, covered stent (arrows) shows good barium flow.

View larger version (112K): [in a new window]   Figure 3e. Patient 6. Distal common bile duct carcinoma invading the duodenum in a 56-year-old woman. (a) Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows a stricture (arrow) in the second portion of the duodenum. Note the metallic biliary stent (arrowhead) placed 402 days earlier to treat jaundice. (b) Anteroposterior upper gastrointestinal radiograph obtained 1 day after stent placement shows good barium passage. The stent migrated 4 days after placement. (c) Anteroposterior upper gastrointestinal radiograph shows that after placement of a second, uncovered stent (arrows), the patent lumen is reestablished. (d) Anteroposterior upper gastrointestinal radiograph obtained 64 days after placement of the second stent reveals recurrent stent stenosis (arrows) because of tumor ingrowth. (e) Anteroposterior upper gastrointestinal radiograph obtained 1 day after placement of a third, covered stent (arrows) shows good barium flow.