Self-expanding coil stent with a long delivery system for palliation of unresectable malignant gastric outlet obstruction: A prospective study

Background and Study Aims: Peroral intubation of a self-expanding metal ste nt is usually difficult in patients with unresectable malignant gastric out let obstruction, because the delivery systems currently available are not l ong enough and cannot easily pass the angulated gastroduodenal structure. W e carried out a prospective study to assess the efficacy of a coil stent wi th a newly developed long delivery system, for palliation of unresectable m alignant gastric outlet obstruction. Patients and Methods: In 29 patients with unresectable malignant gastric ou tlet obstruction, caused by gastric cancer (26 patients), pancreatic head c ancer (two patients), or duodenal cancer (one patient), peroral intubation of a self-expanding nickel-titanium coil stent was attempted, using a lengt hened delivery system of 150cm, under endoscopic and fluoroscopic guidance. Results: Management was successful in 26 of 29 patients (89.7%) without imm ediate major complications. In one patient in whom peroral intubation faile d, percutaneous intubation of the coil stent via percutaneous endoscopic ga strostomy was done. After insertion of the coil stent, food ingestion with symptomatic improvement with regard to vomiting was achieved in 26 of 27 pa tients (96.3%), including the patient with percutaneous stent insertion. Du ring the follow-up period, dysphagia and Karnofsky scores improved signific antly. Stent migration occurred in two patients, and tumor ingrowth in anot her two; re-intervention was done successfully performed in two instances. The mean survival time was 124 days (range 34-310 days) in the 22 patients who had no need for re-intervention during follow-up; among these was a pat ient who experienced stent occlusion by, food material, which was easily co rrected with endoscopic flushing. Conclusions: Peroral intubation of a self-expanding coil stent using a long delivery system is a safe and effective palliative technique for unresecta ble malignant gastric outlet obstruction, and significantly improves the qu ality of life of patients.