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Digestive Disease Interventions 2018; 02(01): 033-039
DOI: 10.1055/s-0038-1639364
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Stent Placement in Surgically Altered Stomach

Jiaywei Tsauo
1   Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Jung-Hoon Park
2   Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
,
Xiaowu Zhang
1   Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
He Zhao
1   Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Ho-Young Song
2   Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
› Author Affiliations Funding None.
Further Information

Publication History

31 October 2017

05 February 2018

Publication Date:
06 April 2018 (online)

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Abstract

Gastric cancer is one of the most common malignancies and among the leading causes of cancer-related deaths worldwide. Radical gastrectomy has been the mainstay of curative treatment for gastric cancer, but recurrent cancer occurs in a significant number of patients. Patients with recurrent cancer can experience debilitating symptoms due to malignant gastric outlet obstruction (GOO). Self-expandable metallic stent (SEMS) placement is effective and safe for the palliative treatment of malignant GOO. However, the technical difficulty of SEMS placement is higher in patients with recurrent cancer due to the surgically altered stomach. Thorough understanding of the surgically altered anatomy and site of stricture is key to favorable treatment outcomes.

Keywords

stomach neoplasms - gastrectomy - gastric outlet obstruction
 

  • References

  • 1 Ferlay J, Soerjomataram I, Dikshit R. , et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (05) E359-E386
    CrossrefPubMedGoogle Scholar
  • 2 Marrelli D, De Stefano A, de Manzoni G, Morgagni P, Di Leo A, Roviello F. Prediction of recurrence after radical surgery for gastric cancer: a scoring system obtained from a prospective multicenter study. Ann Surg 2005; 241 (02) 247-255
    CrossrefPubMedGoogle Scholar
  • 3 Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000; 87 (02) 236-242
    CrossrefPubMedGoogle Scholar
  • 4 Iwanaga T, Koyama H, Furukawa H, Taniguchi H, Wada A, Tateishi R. Mechanisms of late recurrence after radical surgery for gastric carcinoma. Am J Surg 1978; 135 (05) 637-640
    CrossrefPubMedGoogle Scholar
  • 5 Shchepotin I, Evans SR, Shabahang M. , et al. Radical treatment of locally recurrent gastric cancer. Am Surg 1995; 61 (04) 371-376
    PubMedGoogle Scholar
  • 6 Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR. Gastroduodenal stent placement: current status. Radiographics 2004; 24 (06) 1561-1573
    CrossrefPubMedGoogle Scholar
  • 7 Jeurnink SM, Steyerberg EW, Hof Gv, van Eijck CH, Kuipers EJ, Siersema PD. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 2007; 96 (05) 389-396
    CrossrefPubMedGoogle Scholar
  • 8 Jeurnink SM, Steyerberg EW, van Hooft JE. , et al; Dutch SUSTENT Study Group. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71 (03) 490-499
    CrossrefPubMedGoogle Scholar
  • 9 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 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 10 Park CH, Park JC, Kim EH. , et al. Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy. Gastrointest Endosc 2015; 81 (02) 321-332
    CrossrefPubMedGoogle Scholar
  • 11 Song HY, Kim TH, Choi EK. , et al. Metallic stent placement in patients with recurrent cancer after gastrojejunostomy. J Vasc Interv Radiol 2007; 18 (12) 1538-1546
    CrossrefPubMedGoogle Scholar
  • 12 Kim HJ, Park JY, Bang S, Park SW, Lee YC, Song SY. Self-expandable metal stents for recurrent malignant obstruction after gastric surgery. Hepatogastroenterology 2009; 56 (91-92): 914-917
    PubMedGoogle Scholar
  • 13 Park JH, Song HY, Kim SH. , et al. Metallic stent placement in patients with recurrent malignant obstruction in the surgically altered stomach. Ann Surg Oncol 2014; 21 (06) 2036-2043
    CrossrefPubMedGoogle Scholar
  • 14 Thrumurthy SG, Chaudry MA, Hochhauser D, Mughal M. The diagnosis and management of gastric cancer. BMJ 2013; 347: f6367
    CrossrefPubMedGoogle Scholar
  • 15 Chin AC, Espat NJ. Total gastrectomy: options for the restoration of gastrointestinal continuity. Lancet Oncol 2003; 4 (05) 271-276
    CrossrefPubMedGoogle Scholar
  • 16 Stange DE, Weitz J. Methods of Reconstruction—BI, BII, Roux-en-Y, Jejunal Interposition, Proximal Gastrectomy and Pouch Reconstruction. Gastric Cancer. Cham: Springer; 2015: 175-183
    Google Scholar
  • 17 Varadarajulu S, Banerjee S, Barth B. , et al; ASGE Technology Committee. Enteral stents. Gastrointest Endosc 2011; 74 (03) 455-464
    CrossrefPubMedGoogle Scholar
  • 18 Kochar R, Shah N. Enteral stents: from esophagus to colon. Gastrointest Endosc 2013; 78 (06) 913-918
    CrossrefPubMedGoogle Scholar
  • 19 Park JH, Song HY, Kim JH. , et al. Placement of a covered expandable metallic stent to treat nonanastomotic malignant jejunal obstructions after total gastrectomy with esophagojejunostomy. AJR Am J Roentgenol 2012; 198 (05) 1203-1207
    CrossrefPubMedGoogle Scholar
  • 20 Jung GS, Song HY, Kang SG. , et al. Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience. Radiology 2000; 216 (03) 758-763
    CrossrefPubMedGoogle Scholar
  • 21 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 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 22 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 (02) 256-264
    CrossrefPubMedGoogle Scholar
  • 23 Oh D, Lee SS, Song TJ. , et al. Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study. Gastrointest Endosc 2015; 82 (01) 32-36.e1
    CrossrefPubMedGoogle Scholar
  • 24 Isayama H, Sasaki T, Nakai Y. , et al. Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc 2012; 75 (04) 757-763
    CrossrefPubMedGoogle Scholar
  • 25 Baron TH, Harewood GC. Enteral self-expandable stents. Gastrointest Endosc 2003; 58 (03) 421-433
    CrossrefPubMedGoogle Scholar
  • 26 Katsanos K, Sabharwal T, Adam A. Stenting of the upper gastrointestinal tract: current status. Cardiovasc Intervent Radiol 2010; 33 (04) 690-705
    CrossrefPubMedGoogle Scholar
  • 27 Park JH, Song HY, Kim MS. , et al. Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction. Acta Radiol 2013; 54 (03) 267-271
    CrossrefPubMedGoogle Scholar
  • 28 Han K, Song HY, Kim JH. , et al. Afferent loop syndrome: treatment by means of the placement of dual stents. AJR Am J Roentgenol 2012; 199 (06) W761-6
    PubMedGoogle Scholar
  • 29 Lee JM, Han YM, Lee SY, Kim CS, Yang DH, Lee SO. Palliation of postoperative gastrointestinal anastomotic malignant strictures with flexible covered metallic stents: preliminary results. Cardiovasc Intervent Radiol 2001; 24 (01) 25-30
    CrossrefPubMedGoogle Scholar
  • 30 Jeong JY, Kim YJ, Han JK. , et al. Palliation of anastomotic obstructions in recurrent gastric carcinoma with the use of covered metallic stents: clinical results in 25 patients. Surgery 2004; 135 (02) 171-177
    CrossrefPubMedGoogle Scholar
  • 31 Kim JH, Song HY, Shin JH. , et al. Anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy: palliation with covered expandable metallic stents. J Vasc Interv Radiol 2007; 18 (08) 964-969
    CrossrefPubMedGoogle Scholar
  • 32 Yang ZQ, Song HY, Kim JH. , et al. Covered stent placement in patients with recurrent cancer after a Billroth I reconstruction. J Vasc Interv Radiol 2007; 18 (12) 1533-1537
    CrossrefPubMedGoogle Scholar
  • 33 Song GA, Kang DH, Kim TO. , et al. Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents. Gastrointest Endosc 2007; 65 (06) 782-787
    CrossrefPubMedGoogle Scholar
  • 34 Cho YK, Kim SW, Nam KW. , et al. Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer. World J Gastroenterol 2009; 15 (28) 3523-3527
    CrossrefPubMedGoogle Scholar
  • 35 Kim J, Choi IJ, Kim CG. , et al. Self-expandable metallic stent placement for malignant obstruction in patients with locally recurrent gastric cancer. Surg Endosc 2011; 25 (05) 1505-1513
    CrossrefPubMedGoogle Scholar
  • 36 Soo I, Gerdes H, Markowitz AJ. , et al. Palliation of malignant gastric outlet obstruction with simultaneous endoscopic insertion of afferent and efferent jejunal limb enteral stents in patients with recurrent malignancy. Surg Endosc 2016; 30 (02) 521-525
    CrossrefPubMedGoogle Scholar
  • 37 Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36 (06) 543-550
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Zhu HD, Guo JH, Mao AW. , et al. Conventional stents versus stents loaded with (125)iodine seeds for the treatment of unresectable oesophageal cancer: a multicentre, randomised phase 3 trial. Lancet Oncol 2014; 15 (06) 612-619
    CrossrefPubMedGoogle Scholar
  • 39 Moon S, Yang SG, Na K. An acetylated polysaccharide-PTFE membrane-covered stent for the delivery of gemcitabine for treatment of gastrointestinal cancer and related stenosis. Biomaterials 2011; 32 (14) 3603-3610
    CrossrefPubMedGoogle Scholar
  • 40 Kim SY, Kim M, Kim MK. , et al. Paclitaxel-eluting nanofiber-covered self-expanding nonvascular stent for palliative chemotherapy of gastrointestinal cancer and its related stenosis. Biomed Microdevices 2014; 16 (06) 897-904
    CrossrefPubMedGoogle Scholar
  • 41 Lei L, Liu X, Guo S, Tang M, Cheng L, Tian L. 5-Fluorouracil-loaded multilayered films for drug controlled releasing stent application: drug release, microstructure, and ex vivo permeation behaviors. J Control Release 2010; 146 (01) 45-53
    CrossrefPubMedGoogle Scholar