Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 28, 2009; 15(28): 3523-3527
Published online Jul 28, 2009. doi: 10.3748/wjg.15.3523
Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer
Yu Kyung Cho, Sang Woo Kim, Kwan Woo Nam, Jae Hyuck Chang, Jae Myung Park, Jeong-Jo Jeong, In Seok Lee, Myung-Gyu Choi, In-Sik Chung
Yu Kyung Cho, Sang Woo Kim, Kwan Woo Nam, Jae Hyuck Chang, Jae Myung Park, Jeong-Jo Jeong, In Seok Lee, Myung-Gyu Choi, In-Sik Chung, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul 137-040, South Korea
Author contributions: Cho YK wrote the manuscript; Kim SW performed the majority of the procedures; Nam KW, Chang JH, Park JM, Jeong JJ, Lee IS, Choi MG and Chung IS edited the manuscript.
Correspondence to: Dr. Sang Woo Kim, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 505 Banpodong, Seochogu, Seoul 137-040, South Korea. viper@catholic.ac.kr
Telephone: +82-2-22582083
Fax: +82-2-22582089
Received: January 7, 2009
Revised: June 18, 2009
Accepted: June 25, 2009
Published online: July 28, 2009
Abstract

AIM: To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a self-expandable metal stent (SEMS) for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer.

METHODS: The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary’s Hospital, were reviewed retrospectively.

RESULTS: Twenty patients (15 male, mean age 63 years) were included. The operations were a total gastrectomy with esophagojejunostomy (n = 12), subtotal gastrectomy with Billroth-I reconstruction (n = 2) and subtotal gastrectomy with Billroth-II reconstruction (n = 8). The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients (15%) within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-II reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d (range, 5-439 d). The median survival was 83 d (range, 12-439 d).

CONCLUSION: Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer. A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

Keywords: Stents; Surgical anastomosis; Stricture; Endoscopic gastrointestinal surgery; Stomach neoplasms