SEMSs for Malignant Gastric Obstruction: Suggestion of Ideal Stent as Initial Intervention

Background/Aims: Self-expandable metal stents (SEMSs) are effective palliation for malignant gastric outlet obstruction (GOO). Double-layered (Comvi) SEMSs were developed to overcome limitations of uncovered or covered SEMSs. The aims of study were to evaluate efficacy and safety of Comvi stent compared with uncovered and covered stents, and to determine factors related to stent patency. Methods: We retrospectively reviewed data from 224 patients (uncovered, 128; covered, 64; Comvi, 32) with gastric cancer who underwent endoscopic SEMSs placement from 2006 to 2011. Technical and clinical success rates were evaluated and clinical outcomes were compared according to stent types. Stent ingrowth, migration, and patency were evaluated. Results: Technical and clinical success were achieved in 99.6% and 80.4% without immediate complications. Clinical success rate was not significantly different among uncovered, covered, and Comvi groups. The median stent patency time was 156±16.9 days without differences among three groups. The overall 4, 8, 12-week patency rates were 89.4%, 77.3%, and 61.2%, respectively with no differences among three groups. Stent migration was significantly common in order from Comvi, covered, and uncovered stent. However, stent ingrowth was not significantly different among three groups within 8 weeks. Chemotherapy significantly lowered re-intervention rates, especially in uncovered stent. Conclusions: Comvi SEMSs was not more effective than other SEMSs. For diminishing early migration and late ingrowth, uncovered SEMSs with chemotherapy might be more feasible in GOO.