Individualization of metal stents for management of gastric outlet obstruction caused by distal stomach cancer: a prospective study

BackgroundThe use of various kinds of metal stents has emerged as an effective palliative treatment for malignant gastric outlet obstruction (GOO). However, most of these metal stents were designed for use in the esophagus or intestine and have a high incidence of stent obstruction and stent migration when used elsewhere.ObjectiveTo evaluate the efficacy and safety of individualized stents (designed according to the shape and size of the GOO) in order to determine whether such stents could reduce the incidence of stent obstruction and migration.DesignMulticenter, prospective, clinical trial.SettingTwo tertiary-care referral centers.PatientsThirty-seven patients who presented with symptomatic unresectable malignant GOO caused by distal gastric cancer between April 2005 and June 2009.InterventionPlacement of the individualized metal stents.Main Outcome MeasurementsThe primary endpoint was to optimize stent resolution of proximal obstruction as determined by a GOO scoring system. Secondary endpoints were success rates, survival rates, and adverse events.ResultsTechnical and clinical success was achieved in 97.3% and 94.4% of patients, respectively. The rate of resolution of proximal obstruction by a proximal stent was 97.3%. There were no procedure-related perforations or deaths. No stent migration or obstruction by tumor growth were found. The mean survival time was 232 days (range 28-387 days).LimitationsA single-arm study in tertiary-care centers.ConclusionPlacement of individualized stents is a safe and effective modality for the palliation of malignant GOO caused by distal stomach cancer and can help reduce tumor ingrowth and stent migration.