Safety and Efficacy of Self Expandable Metal Stents (SEMS) in Benign Strictures

Abstract

Introduction: This study was performed to test the safety and efficacy of short term fully covered self expandable metal stents (SEMS) in benign strictures of the duodenum, pylorus and anastomoses Methods: Upper endoscopy with through the scope fully covered metal stents (Taewong Corporation) was performed in 19 patients with benign strictures. The location of stricture was; duodenum 4, pylorus 6, gastric bypass anastomoses 6, Whipple with gastrojejunostomy and efferent limb obstruction 3. The pyloric and duodenal stents were left in place for 2 weeks unless jaundice developed (1 patient). The gastric bypass and Whipple gastrojejunostomy stents were left in place for 6 weeks. Stents were removed using standard upper endoscope and Rat Tooth Forceps unless stents migration occurred. 4 point gastric outlet obstruction scoring system was used to record improvement. At least 1 point improvement in score was considered success. Median follow up was 12 months, minimum 4 months, maximum 24 months. Results: Stents were placed successfully in all 19 patients. 18 mm diameter stents were placed in 11 patients, 20 mm diameter stents were placed in 8 patients.10 patients had stent migration. Proximal migration into the stomach from duodenum occurred in 2 patients, distal migration occurred in 8 patients. 2 stents required removal through double balloon enteroscopy. The remaining 6 stents passed spontaneously without consequences. All patients had minimum of 1 point improvement in gastric outlet obstruction score, mean 2 points improvement. 16 patients were able to tolerate soft diet after stent removal. 3 patients were able to tolerate full liquid diet. 2 patients had late recurrence of symptoms, 6 and 12 months later, both were treated with repeat stenting (pyloric stenosis 1, gastric bypass 1). 1 patient developed rising LFTs after duodenal stent placement, this stent was removed on day 6, patient continued to tolerate soft diet after stent removal. No other complications were encountered. Conclusion: Through the scope fully covered SEMS appear to be safe and effective in management of benign strictures in upper GI tract. Stent migration is a limitation, however this can be prevented by suturing the stent.