7083 New self-expanding nitinol stent for palliation of recurrent malignant stenoses of the upper gastrointestinal tract.

Abstract

[Background] Self-expanding metal stents are being used increasingly in palliation of malignant stenoses of unusual locations for stenting, as well as malignant esophageal stenoses. [Aims] We evaluated the role of newly developed covered self-expanding nitinol stent(Niti-s stent, Taewoong Inc., Seoul, Korea) for palliation of recurrent malignant stenoses of the upper GI tract, and compared its results of placement success, complication and symptom relief with those of malignant esophageal and cardiac stenoses. [Methods] We tried to insert nitinol stents in 14 cases of recurrent malignant stenoses(esophagojejunal anastomosis site in 11, gastroesophageal anastomosis site in 3) and 26 cases of malignant esophageal or cardiac stenoses. Stent insertion was performed under fluoroscopic and endoscopic guidance. [Results] 1) The success rate of stent insertion was 92.9%(3/14). The only failed case was in a gastrojejunostomy site due to acute angle. 2) After stent placement the improvement rate of obstruction symptoms was 85.7%, and the mean dysphagia score improved significantly(from 1.71.49 to 0.50.70, p=0.044). 3)Early complication of stent insertion was noted in 7.6%(1/14) such as bleeding. 4) Late complications were noted in 50% such as stent obstruction(4/14), stent migration(2/14), and severe chest pain(1/14). The causes of stent obstruction were tumor ingrowth in 2 and tumor over growth in 1. [Conclusions] Intubation of new covered selfexpanding nitinol stent is an easy, safe and useful precedure for palliation of recurrent malignant stenoses. However, its late complication rate was higher than in malignant esophageal and cardiac stenoses.