Clinical outcomes of self-expandable metallic stents in palliation of malignant anastomotic strictures: a single center experience

Abstract

Background: Self-expandable metallic stents (SEMS) are used as the main nonsurgical palliative treatment for malignant gastric outlet obstruction. Metal stents are also used to treat malignant anastomotic obstructions after esophagojejunostomy, gastrojejunostomy and esophagogastrojejunostomy. Methods: This case series reports prospectively the clinical outcomes of SEMS in the palliation of malignant anastomotic strictures caused by recurrent gastric cancer following gastric surgery as oncological curative treatment, in a series of nine consecutive patients, treated between January 2009 and December 2012 in our center. Results : Nine patients (M:F=8:1) were included. The operation was a total gastrectomy with esophagogastrojejunostomy (n=4), subtotal gastrectomy with Billroth-II reconstruction (n=3), and subtotal gastrectomy with esophagogastrostomy (n=2) .The technical and clinical success rates were 88,9 % and 88,9 %, respectively. The reobstruction of the stent, caused by tumor ingrowth, occurred in 1 patient (11,1%) within 1 month after stenting. Stent migration occurred with a covered stent in 1 patient who underwent a subtotal gastrectomy with Billroth-II reconstruction. A case of partial stent migration was easily treated with a second stent. The median survival period was 180 days (range, 30-240 days) and the median stent patency was 45 days (range, 30-90 days). Conclusions: Although the number of the patients treated with SEMS results, in this series, almost small to certainly judge the safety and feasibility of SEMS, we believe that the endoscopic insertion of SEMS seems to be a safe, technically feasible, and effective treatment for the palliation of anastomotic strictures caused by recurrent gastric cancer. The technical and clinical success, and the onset of complications of this procedure are influenced by several factors, such as the type of anastomosis, the technical features of the stent, and the extent of the underlying tumor.