Self-expanding metallic stents for gastric outlet obstruction resulting from stomach cancer: a preliminary study with a newly designed double-layered pyloric stent

BACKGROUND: Although endoscopic stent placement is now generally accepted as a palliative treatment for gastric outlet obstruction resulting from gastric cancer, it carries potential limitations such as tumor ingrowth or migration. OBJECTIVE: Our purpose was to evaluate the technical and clinical efficacy of endoscopic placement of a newly designed double-layered combination pyloric stent. DESIGN: Prospective, uncontrolled, single-center. SETTING: Tertiary referral university hospital. PATIENTS: Eleven patients with gastric outlet obstruction by unresectable stomach cancer. INTERVENTIONS: Eleven patients received a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner polytetrafluoroethylene-covered stent to prevent tumor ingrowth). MAIN OUTCOME MEASUREMENT: To evaluate technical success, clinical success, and complications, especially tumor ingrowth and migration. RESULTS: Technical success was achieved in 11 of 11 (100%) patients. Among 11 patients in whom endoscopic stenting was placed successfully, clinical success was 90.9%, tumor ingrowth 0%, migration 9.1%, and tumor overgrowth 9.1%. Median stent patency period was 121 days. LIMITATIONS: Small number of patients, uncontrolled study, short-term follow-up period. CONCLUSIONS: We have described a technique for endoscopic metal stent placement by using the newly designed double-layered combination stent for gastric outlet obstruction by stomach cancer. This stent seems to be effective and looks promising for technical efficacy, clinical outcome, and preventing tumor ingrowth and migration.