Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents

Abstract

Background. The placement of self-expandable metallic stents (SEMS) is known to be effective palliative treatment of malignant gastroduodenal obstruction. There are two types of SEMS Á covered and uncovered Á each with its own advantages and disadvantages. This study was conducted to compare between the clinical outcomes of covered and uncovered stents in patients with malignant gastroduodenal obstruction. Patients and methods. The study was conducted prospectively from January 1998 to June 2007 and 154 patients were included. All had symptomatic gastroduodenal obstruction and were not candidates for curative operation. Seventy patients received covered SEMS, while the other 84 received uncovered SEMS. We compared technical and clinical success rates, tumour ingrowth rate, stent migration rate, stent patency time and patient survival in both SEMS groups. Results. The technical and clinical success rates of the covered and uncovered stent groups did not differ. Stent migration was more frequent in the covered stent group than in the uncovered group (17.1% versus 0%; p00.0001). Tumour ingrowth was more frequent in the uncovered stent group than in the covered group (16.6% versus 2.9%; p00.0066). Stent re-intervention rate, stent patency time and patient survival did not differ between groups. Conclusion. Covered and uncovered stent insertions are technically feasible and effective palliative treatment of malignant gastroduodenal obstruction. Covered stents can reduce the risk of tumour ingrowth, whereas uncovered stents are effective in preventing stent migration. However, covered stents did not differ from uncovered stents in regard to other clinical outcomes.

Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction

“…Multivariate analysis revealed that the presence of a stent bridging the duodenal papilla [odds ratio (OR) =18.48; 95% CI, 2.298-148.48; P=0.006] was an independent predictor of acute pancreatitis. Table 2 shows the results of comparisons between CMS and UCMS in a prospective study and four randomized controlled trials (23)(24)(25)(26)(27). The technical and clinical success rates were similar between CMS and UCMS in all of these reports.…”

“…The technical and clinical success rates were similar between CMS and UCMS in all of these reports. As an adverse event, the migration rate was significantly lower in the UCMS group in three of these five reports (23)(24)(25). However, Maetani et al reported that there was no significant difference in the migration rate between CMS and UCMS because the 15-mm uncovered portion at both ends of the UCMS prevented stent migration (26).…”

Malignant Gastric Outlet Obstructions: Treatment with Self-Expandable Metallic Stents

“…Stent re-intervention rates and stent patency and patient survival periods were similar in these two groups. 47 In the second study, retrospective in design, 40 technical/clinical success rates, stent patency time, and patient survival period did not differ between the covered (n=29) and bare (n=32) stent groups. Moreover, the rate of complications (including reobstruction, migration, bleeding, and stent fracture) did not differ significantly between the two groups.…”

“…Two recent studies compared the clinical outcomes of covered and bare stents in the palliative treatment of malignant GOO. 40,47 A prospective, non-randomized study 47 found that the technical and clinical success rates were similar in patients receiving covered (n=70) and bare metal (n=84) stents. Stent migration was significantly more frequent in the covered than in the bare stent group (17.1% vs 0%; p ＜0.001), whereas tumor ingrowth was more frequent in the bare than in the covered stent group (16.6% vs 2.9%; p=0.0066).…”

“…40 Differences in study results may have been due to differences in patient demographics, stent type, and/or patient survival period. 40,47 A large, prospective, randomized trial is required to find the ideal stent for patients with malignant GOO. 40,47 …”