Malignant gastroduodenal obstructions: Treatment by means of a covered expandable metallic stent - Initial experience

PURPOSE: To investigate the technical feasibility and clinical effectivenes s of a polyurethane-covered expandable nitinol stent in the treatment of ma lignant gastroduodenal obstructions. MATERIALS AND METHODS: The stent was constructed in-house by weaving a sing le thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant g astric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All pat ients had severe nausea and recurrent vomiting, and their obstructions were inoperable. RESULTS: Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had a nother stenosis at the proximal jejunum. One patient with stent placement i n the second portion of the duodenum became jaundiced. During the mean foll ow-up of 11 weeks, stent migration occurred in five patients 1-4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showe d recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results. CONCLUSION: Placement of a polyurethane-covered expandable nitinol stent se ems to be technically feasible and effective for palliative treatment of in operable malignant gastroduodenal obstructions. Stent migration, however, i s problematic and requires further investigation.