Brief Article
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World J Gastroenterol. Oct 7, 2013; 19(37): 6199-6206
Published online Oct 7, 2013. doi: 10.3748/wjg.v19.i37.6199
SEMS vs cSEMS in duodenal and small bowel obstruction: High risk of migration in the covered stent group
Oliver Waidmann, Jörg Trojan, Mireen Friedrich-Rust, Christoph Sarrazin, Wolf Otto Bechstein, Frank Ulrich, Stefan Zeuzem, Jörg Gerhard Albert
Oliver Waidmann, Jörg Trojan, Mireen Friedrich-Rust, Christoph Sarrazin, Stefan Zeuzem, Jörg Gerhard Albert, Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Klinikum der Johann Wolfgang Goethe-Universität, D-60590 Frankfurt/Main, Germany
Wolf Otto Bechstein, Frank Ulrich, Klinik für Allgemein und Viszeralchirurgie Klinikum der Johann Wolfgang Goethe-Universität, D-60590 Frankfurt/Main, Germany
Author contributions: Waidmann O and Albert JG designed the research; Waidmann O, Trojan J, Friedrich-Rust M, Sarrazin C, and Albert JG performed the research; Waidmann O, Bechstein WO, Ulrich F, Zeuzem S, and Albert JG analyzed the data; Waidmann O and Albert JG wrote the paper; all authors finally approved the version to be published.
Correspondence to: Dr. Jörg Gerhard Albert, Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany. j.albert@med.uni-frankfurt.de
Telephone: +49-69-63015297 Fax: +49-69-63016247
Received: March 19, 2013
Revised: April 20, 2013
Accepted: June 8, 2013
Published online: October 7, 2013
Processing time: 213 Days and 11.9 Hours
Abstract

AIM: To compare clinical success and complications of uncovered self-expanding metal stents (SEMS) vs covered SEMS (cSEMS) in obstruction of the small bowel.

METHODS: Technical success, complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed. The primary end points were rates of stent migration and overgrowth. Secondary end points were the effect of concomitant biliary drainage on migration rate and overall survival. The data was analyzed according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

RESULTS: Thirty-two SEMS were implanted in 20 patients. In all patients, endoscopic stent implantation was successful. Stent migration was observed in 9 of 16 cSEMS (56%) in comparison to 0/16 SEMS (0%) implantations (P = 0.002). Stent overgrowth did not significantly differ between the two stent types (SEMS: 3/16, 19%; cSEMS: 2/16, 13%). One cSEMS dislodged and had to be recovered from the jejunum by way of laparotomy. Time until migration between SEMS and cSEMS in patients with and without concomitant biliary stents did not significantly differ (HR = 1.530, 95%CI 0.731-6.306; P = 0.556). The mean follow-up was 57 ± 71 d (range: 1-275 d).

CONCLUSION: SEMS and cSEMS placement is safe in small bowel tumor obstruction. However, cSEMS is accompanied with a high rate of migration in comparison to uncovered SEMS.

Keywords: Endoscopy; Digestive system; Intestinal neoplasms; Self-expandable metal stents; Tumor obstruction; Self-expandable metal stents complications

Core tip: Gastrointestinal obstruction is a complication of advanced cancer disease. It heavily impacts on patients’ general condition. Endoscopic implantation of self-expanding metal stents (SEMS) is a safe and established procedure for palliative treatment of tumor obstruction. Covered SEMS are considered favorable concerning reobstruction by inhibiting tumor ingrowth. In contrast, uncovered SEMS might harbor a lower risk of migration and dislocation. In the present study covered SEMS were retrospectively compared with uncovered SEMS in patients with small bowel or duodenal obstruction. Significantly higher migration rates were observed in the covered SEMS group without observing significant increase of the rate of patients with tumor ingrowth indicating that uncovered SEMS should be favored for palliative treatment of tumor obstruction of the duodenum or the small bowel.