Palliation of Malignant Gastric Obstruction: Fluoroscopic-Guided Covered Metallic Stent Placement

Abstract

Purpose : To demonstrate the feasibility and clinical efficacy of self-expanding, covered, metallic stent placement for the palliative treatment of malignant gastric obstruction. Materials and Methods : Under fluoroscopic guidance, the placement of self-expanding, covered stents was attempted in 23 patents (age range, 31-78 years) with inoperable or re-current gastric malignancies. All 23 suffered dysphagia and/or vomiting after the ingestion of soft foods, or swallowing difficulty. Three different types of self-expanding, covered metallic stents were used and in all patients, these were placed perorally using the over the guide wire technique. Success was defined both technically and clinically. Results : Stent placement was technically successful in 19 patients (82.6 %) but because the guidewire failed to successfully negotiate the sites at which there was obstruction, was unsuccessful in four (17.4 %). Stent placement was well tolerated in all patients except one, in whom an acutely angled efferent loop from remnant stomach was present. In this case, stent placement required a strong metallic guidewire. After placement, 17 of the 19 patients (89.5 %) were able to ingest solid and/or soft foods without dysphagia and showed a markedly decreased incidence of vomiting. Two others showed some improve-ment in the frequency of vomiting but were able to ingest only a liquid diet. In one patient, the stent migrated two days after the procedure. During the follow-up period of 2-7 months (mean, 74 days), there were no clinically significant complications. Conclusion : For the short-term palliative treatment of patients with gastric inlet or outlet obstructions, the placement of self-expanding metallic stents has proven relatively easy and safe, as well as reasonably effective.