High proximal migration rate of a partially covered “big cup” duodenal stent in patients with malignant gastric outlet obstruction

Endoscopic placement of self-expandable metal stents (SEMS) has emerged as a palliative treatment for patients with malignant gastric outlet obstruction (GOO). Recently, a new partially covered “big cup” SEMS has been developed to prevent both stent migration and tissue ingrowth. The aim of the study was to evaluate safety and efficacy of this SEMS in a cohort of patients with incurable malignant GOO. The study was terminated prematurely due to three proximal stent migrations in six patients. Migrations occurred at 2, 4, and 29 days, respectively, and necessitated endoscopic removal and placement of another SEMS. The remaining three patients had a patent SEMS at the end of follow-up. The high proximal migration rate of this new SEMS should be taken into account when considering routine clinical use in malignant GOO. Further research is warranted in order to find an optimal stent design that prevents both stent migration and tumor ingrowth.

• References

• 1 Dormann A, Meisner S, Verin N et al. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36: 543-550
• 2 van Hooft JE, Uitdehaag MJ, Bruno MJ et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 2009; 69: 1059-1066
• 3 van den Berg MW, Haijtink S, Fockens P et al. First data on the Evolution duodenal stent for palliation of malignant gastric outlet obstruction (DUOLUTION study): a prospective multicenter study. Endoscopy 2013; 45: 174-181
• 4 Costamagna G, Tringali A, Spicak J et al. Treatment of malignant gastroduodenal obstruction with a nitinol self-expanding metal stent: an international prospective multicentre registry. Dig Liver Dis 2012; 44: 37-43
• 5 Kim JH, Song HY, Shin JH et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 2007; 66: 256-264
• 6 Jeurnink SM, Steyerberg EW, van Hooft JE et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
• 7 No JH, Kim SW, Lim CH et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013; 78: 55-62
• 8 Kim CG, Choi IJ, Lee JY et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 2010; 72: 25-32
• 9 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
• 10 Adam A, Morgan R, Ellul J et al. A new design of the esophageal Wallstent endoprosthesis resistant to distal migration. AJR Am J Roentgenol 1998; 170: 1477-1481
• 11 Park DH, Lee SS, Lee TH et al. Anchoring flap versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos). Gastrointest Endosc 2011; 73: 64-70
• 12 Jeurnink SM, Steyerberg EW, Hof G et al. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 2007; 96: 389-396
• 13 van Hooft JE, Dijkgraaf MG, Timmer R et al. Independent predictors of survival in patients with incurable malignant gastric outlet obstruction: a multicenter prospective observational study. Scand J Gastroenterol 2010; 45: 1217-1222