Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2018; 24(40): 4578-4585
Published online Oct 28, 2018. doi: 10.3748/wjg.v24.i40.4578
Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy
Seung Han Kim, Bora Keum, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim, Sungsoo Park
Seung Han Kim, Bora Keum, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
Sungsoo Park, Division of Upper GI Surgery, Department of Surgery, Korea University College of Medicine, Seoul 02841, 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 , Kim CD, Park S, Choi HS, Seo YS, and Um SH analyzed the data; and Kim SH wrote the manuscript.
Supported by a Korea University Grant, No. K1809701; and the Ministry of Trade, Industry &Energy (MOTIE, Korea) under the Industrial Technology Innovation Program, No. 10060251; ‘Development of diagnostic device for functional dyspepsia based on Korean-Western medicine fusion abdominal diagnosis’.
Institutional review board statement: The study was reviewed and approved by the Korea University Anam Hospital Institutional Review Board.
Informed consent statement: All 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: Bora Keum, MD, PhD, Professor, 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 136705, South Korea. borakeum@hanmail.net
Telephone: +82-2-9206555 Fax: +82-2-9531943
Received: July 19, 2018
Peer-review started: July 19, 2018
First decision: August 25, 2018
Revised: September 11, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 28, 2018
Processing time: 100 Days and 0 Hours
ARTICLE HIGHLIGHTS
Research background

Delayed gastric emptying (DGE) after gastric surgery is one of the main postoperative complications. However, there have been no appropriate treatment measures for this distressing clinical situation. Recently, self-expandable metallic stent (SEMS) placement has become an effective and practical method not only for the management of gastrointestinal malignancy-associated problems but also for benign stenosis or leaks of the gastrointestinal tract.

Research motivation

The currently available methods for postoperative DGE might present less effective outcomes or potential morbidities associated with medications or surgical procedures.

Research objectives

The objective of this study was to analysis whether SEMS placement in the outlet area may facilitate rapid resumption of oral food intake and recovery of the general condition, resulting in shorter hospital stays in patients with DGE after gastrectomy.

Research methods

We prospectively collected data from 20 patients who underwent stent insertion for postoperative DGE. We recorded the diagnosis, type of gastric procedure performed, hospital course, postoperative day when oral food intake was resumed, and postoperative problems. Assessment for clinical improvement, complications, and consequences after stent insertion were performed.

Research results

Stent placement for postoperative DGE relieved obstructive symptoms rapidly, shortened hospital stay, and increased patient satisfaction and quality of life. Endoscopic stent placement presented a high technical success rate and rapid symptom improvement in patients with postoperative DGE. Moreover, no further surgical procedures were necessary in all cases. Endoscopic stenting could be considered a useful treatment option for DGE after gastrectomy.

Research conclusions

This study showed the efficacy of SEMS insertion for DGE following surgical gastrectomy. Endoscopic stent placement provides prompt relief of obstructive symptoms due to various causes after distal gastrectomy. The stenting procedure itself is a minimally invasive therapeutic alternative, which can be performed via simple fluoroscopy-guided endoscopy. After stent insertion, patients did not require prolonged fasting or hospitalization, the quality of life of the patients improved, and adverse events did not occur. Physicians could consider stent placement in patients with postoperative DGE, especially, when rapid oral diet resumption could be helpful for patients.

Research perspectives

Endoscopic stent placement, which is minimal invasive procedure, resulted in a high technical success rate and rapid symptom improvement in patients with postoperative DGE. In future research, direct comparison of clinical efficacy between stent placement and other therapeutic method could be helpful for physicians.