Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study

Figure 1 Case of hepatocellular carcinoma. A: Cholangiogram showing a biliary stricture caused by primary tumor and lymph node metastasis in the right hepatic duct and middle bile duct (arrow heads); B: A self-expandable metal stent was inserted endoscopically; C, D: Coronal sections of contrast-enhanced computed tomography images show duodenal invasion of lymph node metastasis (arrow heads); E: Endoscopic view showing the oral side of the stricture at the superior duodenal angle; F: Injection of contrast material demonstrates a stricture in the second duodenal segment (arrow heads); G, H: A nitinol metal stent was placed in the shape of the character “C” from the stomach pylorus to the third duodenal segment (G: Endoscopic view; H: X-ray); I: X-ray image taken 1 wk later shows sufficient expansion and stability of the duodenal stent.

Figure 2 Differences between the Gastric Outlet Obstruction Scoring System score at baseline and at 14 d after stent placement are shown (A) and the mean Gastric Outlet Obstruction Scoring System scores at baseline and after 14 d are shown (B). P-value of the Wilcoxon signed-rank test comparison was < 0.0001. GOOSS: Gastric Outlet Obstruction Scoring System.

Figure 3 Kaplan-Meier curve showing stent patency.