Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1580-1587
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1580
Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction
Ji Won Kim, Ji Bong Jeong, Kook Lae Lee, Byeong Gwan Kim, Dong Won Ahn, Jae Kyung Lee, Su Hwan Kim
Ji Won Kim, Ji Bong Jeong, Kook Lae Lee, Byeong Gwan Kim, Dong Won Ahn, Jae Kyung Lee, Su Hwan Kim, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea
Author contributions: Kim JW performed the data analysis and wrote the paper; Jeong JB designed the study and supervised the entire research project; Lee KL and Kim BG revised the manuscript for intellectual content; Ahn DW, Lee JK and Kim SH obtained the data; all authors reviewed and approved the final version of the manuscript.
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: Ji Bong Jeong, MD, PhD, Assistant Professor, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul 156-707, South Korea. jibjeong@snu.ac.kr
Telephone: +82-2-870-2222 Fax: +82-2-870-3863
Received: July 23, 2014
Peer-review started: July 24, 2014
First decision: August 15, 2014
Revised: September 3, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: February 7, 2015
Processing time: 201 Days and 8.2 Hours
Abstract

AIM: To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.

METHODS: A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.

RESULTS: The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).

CONCLUSION: Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.

Keywords: Duodenal obstruction; Stents; Palliative treatment; Gastric outlet obstruction; Neoplasms

Core tip: Malignant duodenal obstruction is a terminal event in patients with pancreatic, hepatobiliary, duodenal, and metastatic cancer. In these patients, maintenance of oral food intake is crucial because it is essential to their quality of life. However, comparison of clinical outcomes between uncovered and covered stent placements have been not well evaluated in malignant duodenal obstruction. Our results show that uncovered stents may be preferable in patients with malignant duodenal obstruction because of their greater resistance to stent migration and longer overall duration of stent patency than those of covered stents.