Initial Experience with Song's Covered Duodenal Stent in the Treatment of Malignant Gastroduodenal Obstruction

Abstract

Initial experience with use of Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction is reported. Sixteen consecutive patients with malignant gastroduodenal obstruction were treated with peroral placement of Song's covered duodenal stent. The mean age was 58 years (range, 28-90 y). Gastroduodenal obstruction was caused by gastric (n = 8), metastatic (n = 2), gallbladder (n = 3), pancreatic (n = 2), or ampullary (n = 1) cancer. The disease was considered inoperable in all patients. With use of a flexible 20-F introducing system, seven fully covered, three uncovered, and 10 partially covered duodenal stents were placed under fluoroscopic guidance. The technical success rate was 94% (15 of 16) with no major complications. Symptoms of gastroduodenal obstruction improved in 14 patients. Stent migration was observed in three of seven fully covered stents. Patients with migrated stents required endoscopic stent removal and placement of uncovered duodenal stents. Tumor ingrowth was observed in two thirds of uncovered stents. In the 10 procedures with partially covered duodenal stents, no migration or tumor ingrowth was observed. All patients died 1-48 weeks (mean, 12 weeks) after stent placement. Peroral placement of Song's covered duodenal stent is a feasible and effective method of palliation in the majority of patients with malignant gastroduodenal obstruction. Migration of fully covered stents and tumor ingrowth of uncovered stents are important limitations that can be overcome with the use of a partially covered duodenal stent.