Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

Kentaro Yamao, Masayuki Kitano, Yasutaka Chiba, Takeshi Ogura, Takaaki Eguchi, Ichiro Moriyama, Yukitaka Yamashita, Hironari Kato, Takahisa Kayahara, Noriyuki Hoki, Yoshinobu Okabe, Hideyuki Shiomi, Yoshitaka Nakai, Yoshinori Kushiyama, Yoshifumi Fujimoto, Shiro Hayashi, Shigeki Bamba, Yasushi Kudo, Nobuaki Azemoto, Toshiharu UekiNorimitsu Uza, Masanori Asada, Kazuya Matsumoto, Hiroko Nebiki, Hiroshi Takihara, Chisio Noguchi, Hideki Kamada, Kojiro Nakase, Daisuke Goto, Tsuyoshi Sanuki, Tetsuya Koga, Shinichi Hashimoto, Hidefumi Nishikiori, Masahiro Serikawa, Keiji Hanada, Ken Hirao, Masaya Ohana, Imakiire Kazuyuki, Takao Kato, Motoyuki Yoshida, Hirofumi Kawamoto

Research output: Contribution to journalArticlepeer-review

Abstract

Objective Stenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results. Design In a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours. Results Overall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01). Conclusions Due to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

Original languageEnglish
Pages (from-to)1244-1252
Number of pages9
JournalGut
Volume70
Issue number7
DOIs
Publication statusPublished - Jul 1 2021

Keywords

  • gastrointesinal endoscopy
  • stents

ASJC Scopus subject areas

  • Gastroenterology

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