Self-expandable metal stents in the treatment of antro-pyloric and/or duodenal strictures

Purpose: To assess the usefulness of self-expandable metal stents in the re canalization of antro-pyloric and/or duodenal strictures. Material and Methods: We report our experience of 15 patients with inoperab le antro-pyloric and/or duodenal strictures treated by implantation of 21 s elf-expandable metal stents (18 uncovered and 3 covered) inserted perorally under fluoroscopic guidance. The patients were 11 men and 4 women, mean ag e 65.3 years. Fourteen of 15 patients were affected by a malignant strictur e of the antro-pyloric region and/or duodenum either primary or secondary i n 10 and 4 cases, respectively. Only in 1 case there was a benign stricture from postoperative scarring. Stricture length and diameter varied from 3 t o 9 cm (mean 5.4 cm) and from 0 to 4 mm (mean 1.27 mm), respectively. Results: Twenty-one stents were placed in 15 patients: Technical success wa s achieved in all cases while clinical improvement was obtained in 14 cases . No short-term complications were observed. A mean 4.3-month follow-up was obtained. Two patients had emesis secondary to peritoneal dissemination of the tumor after 1 and 2 months, respectively. Two other patients showed tu mor overgrowth of the oral edge of the prosthesis after 3 and 2 months, res pectively, and required another coaxial stent to bridge the new stenosis. T he patient treated for a benign stricture had jaundice after 3 months and p ercutaneous internal-external biliary drainage was necessary. Conclusion: Self-expandable metal stents are a safe and effective treatment of antro-pyloric and duodenal strictures; therefore, they should be consid ered an alternative to palliative resection in cases of advanced stage dise ase or poor general physical condition.