Self-expandable metallic stents in malignant gastric outlet obstructions -an alternative approach using modified techniques

Malignant gastric outlet obstructions are commonly present in an advanced t umor stage. Surgery and other therapy options are often accompanied with su bstantial problems and reduced quality of life. We therefore investigated t he endoscopic palliation with self-expandable metallic stents. This report documents the clinical benefit of new stent systems. During a period of eleven months we implanted eleven self-expandable metall ic stents (one Ultraflex Esophageal Stent/five Ultraflex Duodenal Diamond S tents/five Enteral Wallstents) in eight patients with malignant gastric out let stenoses (five female/three male, average age 66 years, range 42-85 yea rs). The procedure was performed under analgosedation and in seven cases on an outpatient bases. The stenosis could be dilated in all cases without complications, allowing semi-liquid oral feeding at the procedure day. Three patients needed a seco nd stent in the follow-up. Stent dislocation appeared in one case after one month - the stent protruded per vias naturales. The stent struts broke in two patients after one and four months post stent implantation. A new stent could be inserted without complications in both cases. The used products enabled a fast and precise positioning of the metallic st ent in malignant gastric outlet stenosis. We experienced some problems with the Ultraflex Duodenal Diamond Stent. This didn't occur with the Enteral W allstent. Additionally with the Enteral Wallstent we could solve the diamon d stent complications. Due to the small diameter (10 French) the Enteral Wa llstent system can be positioned wire guided in the stenosis through the wo rking channel of the endoscope. Stent release is performed fluoroscopically and with the use of endoscopic guidance retaining the instrument in the st omach. In our point of view, this metallic stent is an optimal device for t he palliative treatment of malignant gastric outlet obstructions.