2214 Peroral intubation of self-expanding metal stents for palliation of inoperable gastric cancer with antral obstruction.

Abstract

Background: Peroral intubation of self-expanding metal stent(SEMS) seems to be faster and more durable than other nonsurgical modalities in malignant gastrointestinal obstruction. However, it is very difficult in malignant obstruction of the gastric antrum in patients with inoperable gastric cancer due to the curved anatomic structure of the gastroduodenal axis. Methods: Placement of 18 endocoil stents( In stent Inc., Eden Prairie, Minn., U.S.A), 11 modified Gianturco Z-stent(Choo stent, Sooho Medi-Tech Co., Ltd., Seoul, Korea) and 66 nitinol through-the-scope(TTS) stents (Niti- S, Taewoong Inc., Seoul, Korea) were attempted in 95 consecutive patients suffering from intractable vomiting due to inoperable gastric cancer with antral obstruction. Results: Technical success was achieved in 83.3%(15/18)of endocoil stent group, 90.9%(10/11) of modified Z-stent group and 100%(66/66) of TTS stent group. Procedure-related complications included bowel injury by the tip of the guide wire in 2 of modified Zstent group and 3 of TTS stent group, who were managed with conservative treatment. After SEMS placement, restoration of oral food intake and relief of vomiting was achieved in 93.3%(14/15)of endocoil stent group, 80.0%(8/10) of modified Z-stent group and 96.9%(63/66), respectively. Early complications included stent migration into the stomach in 1 of modified Zstent group. During the follow-up, stent occlusion occurred in each one of endocoil and TTS stent group by food materials, in 9 of TTS stent group by tumor ingrowth, and in 2 of TTS stent group by tumor overgrowth. There were no delayed serious complications, such as stent migration or GI bleeding. Conclusion: These results suggest that peroral intubation of SEMSs, especially nitinol TTS stent, is effective non-surgical palliation for inoperable gastric cancer with antral obstuction.