A Novel Partially Covered Self-Expandable Metallic Stent with Proximal Flare in Patients with Malignant Gastric Outlet Obstruction

作者：Takahara Naminatsu; Isayama Hiroyuki^*; Nakai Yousuke; Yoshida Shuntaro; Saito Tomotaka; Mizuno Suguru; Yagioka Hiroshi; Kogure Hirofumi; Togawa Osamu; Matsubara Saburo; Ito Yukiko; Yamamoto Natsuyo; Tada Minoru; Koike Kazuhiko

来源：Gut and Liver, 2017, 11(4): 481-488.

DOI：10.5009/gnl16259

• Gastric outlet obstruction
• Self expandable metal stent
• Endoscopic stent placement

Background/Aims: Endoscopic placement of self-expandable metal stents (SEMSs) has emerged as a palliative treatment for malignant gastric outlet obstruction (GOO). Although covered SEMSs can prevent tumor ingrowth, frequent migration of covered SEMSs may offset their advantages in preventing tumor ingrowth. Methods: We conducted this multicenter, single-arm, retrospective study at six tertiary referral centers to evaluate the safety and efficacy of a partially covered SEMS with an uncovered large-bore flare at the proximal end as an antimigration system in 41 patients with symptomatic malignant GOO. The primary outcome was clinical success, and the secondary outcomes were technical success, stent dysfunction, adverse events, and survival after stent placement. Results: The technical and clinical success rates were 100% and 95%, respectively. Stent dysfunctions occurred in 17 patients (41%), including stent migration in nine (23%), tumor ingrowth in one (2%), and tumor overgrowth in four (10%). Two patients (5%) developed adverse events: one pancreatitis and one perforation. No procedure-related death was observed. Conclusions: A novel partially covered SEMS with a large-bore flare proximal end was safe and effective for malignant GOO but failed to prevent stent migration. Further research is warranted to develop a covered SEMS with an optimal antimigration system.

• 出版日期2017-7