Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9134-9141
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9134
Predictors of the patency of self-expandable metallic stents in malignant gastroduodenal obstruction
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
Seung Han Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Kim SH, Keum B and Chun HJ designed the research study; Kim SH and Keum B performed the research; Kim ES, Jeen YT, Lee HS and Kim CD assisted in creating the tables and figures; Nam SJ, Choi HS, Seo YS and Um SH analyzed the data; and Yoo IK and Lee JM wrote the manuscript.
Supported by Technology Innovation Program (or Industrial Strategic technology development program), No. 10049743, Establishing a medical device development open platform, as a hub for accelerating close firm-hospital communication) funded By the Ministry of Trade, industry and Energy (MI, South Korea).
Institutional review board statement: The study was reviewed and approved by the Korea University Anam Hospital Institutional Review Board.
Informed consent statement: All of the study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hoon Jai Chun, MD, PhD, AGAF, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul 136-705, South Korea. drchunhj@chol.com
Telephone: +82-2-9206555 Fax: + 82-2-9531943
Received: February 25, 2015
Peer-review started: February 26, 2015
First decision: March 10, 2015
Revised: April 12, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: August 14, 2015
Processing time: 173 Days and 2.1 Hours
Abstract

AIM: To investigate the predictive factors of self-expandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction.

METHODS: A total of 116 patients underwent stent placements for inoperable malignant gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization’s scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency.

RESULTS: Self-expandable metallic stent placement was technically successful in all patients (100%), and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model, carcinoembryonic antigen (CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio (aHR) = 2.92, 95%CI: 1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency (P = 0.009; aHR = 0.27, 95%CI: 0.10-0.72).

CONCLUSION: CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.

Keywords: Malignant gastroduodenal obstruction; Stent; Patency; Predictive factor; Carcinoembryonic antigen

Core tip: Self-expandable metallic stent placement is an effective palliative treatment in patients who have inoperable malignant gastroduodenal obstruction. However, clinical parameters associated with stent patency have been controversial. This retrospective study investigated the potential predictive factors of stent patency. We found that carcinoembryonic antigen level is an easily determined parameter that is associated with stent patency in malignant gastroduodenal obstruction.