The covered self-expandable metal stent and suturing technique for malignant gastric pyloric and duodenal stenosis

Aims Self-expandable metallic stents (SEMS) are commonly used for the treatment of a malignant stenosis of the gastric pylorus and duodenum. Both uncovered SEMS (UCSEMS) and covered SEMS (CSEMS) can be used, though UCSEMS is preferred due to the risk of migration with CSEMS, despite no clear difference in efficacy. There have been reports of using clips or other fixation technique to prevent migration, but their preventive effect is limited. CSEMS can prevent tissue ingrowth and may also help control tumor-related bleeding, potentially preventing anemia. To maximize the advantages of CSEMS while minimizing its disadvantages, we used an endoscopic hand-suturing device to secure the CSEMS to the gastric mucosa. This technique, which we have previously reported, is referred to as the stent placement and suturing technique. Here, we share our experience with this technique as performed at our institution.

Methods We retrospectively analyzed five patients who underwent the stent placement and suturing technique at Showa University Koto Toyosu Hospital between December 2023 and October 2024. We evaluated the occurrence of complications, procedural time, the rate of stent migration during the observation period, and the need for blood transfusion. The procedure utilized a CSEMS (HANAROSTENT Naturfit Flare duodenum/pylorus stent, Boston Scientific), an endoscopic hand-suturing device (SutuArt; Olympus Medical Systems, Tokyo, Japan), and V-Loc sutures (3-0, 17mm, Medtronic, Dublin, Ireland).

Results The median age of the patients was 72 years (range, 64-85), with a male-to-female ratio of 3:2. The median follow-up period was 23 days (range, 6-76). The underlying conditions were due to direct tumor invasion or lymph node enlargement (2 cases of pancreatic head cancer, 1 case of gallbladder cancer, 1 case of duodenal cancer, and 1 case of hepatic cancer with lymph node metastasis). The median suturing time was 37 minutes (range, 29-90), and the median total procedure time was 58 minutes (range, 47-114). No intraoperative or postoperative complications were observed, and the procedures were completed safely. The migration rate during the observation period was 0% (0/5), and no re-intervention was necessary. Although all patients required blood transfusion prior to the procedure, none required transfusion after the procedure.

Conclusions This technique can be safely performed without complications. No stent migration was observed, and the progression of anemia was effectively controlled, thus eliminating the need for further transfusions. This approach not only prevents stent migration but may also reduce the need for transfusions, which are frequently required in patients with advanced malignancies. This technique was safely applied regardless of cancer type or lymph node involvement. Furthermore, as the stent is secured with sutures, it remains removable if necessary. Given the patient's prognosis, early intervention may be beneficial in patients with obstructive symptoms to optimize clinical outcomes [1].

Publication History

Article published online:
27 March 2025

• References

• 1 Endoscopy. 2024 56. E422-E423