Outcome of Self-expandable Metallic Stent Deployment in Patients with Malignant Gastroduodenal Outlet Obstruction and Niti-S and WallFlex Comparison: a Multicenter Retrospective Clinical Study

Abstract

Background

Several studies report on the outcomes of self-expandable metallic stents (SEMS) deployment for malignant gastric outlet obstruction (GOO). However, data was based on the analysis of single center studies. Additionally, only a small number of patients was included, despite a prospective multicenter study in most reports.

Aims: The evaluation of clinical outcomes after the deployment of SEMS in patients with malignant GOO in addition to a comparison of the clinical outcomes of two metallic stents with different designs.

Methods

One hundred and twenty-five consecutive patients at five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric and WallFlex duodenal stents was also undertaken.

Results

Rates for clinical and technical successes were 100% and 92%, respectively. The median stent patency and survival periods were 72 (range: 3–775) and 75 days (range: 3–775), respectively. The rate of overall adverse events was 29%. The rate of stent dysfunction was 17%, and that of adverse events, except stent dysfunction, was 12%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S was significantly higher than that for WallFlex (96.2% vs. 84.8%, P = 0.023).

Conclusions

We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral intake of food. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.

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