nitinol and Duodenal-Obstruction

A conformable self-expandable metallic stent was developed to overcome the limitation of previous self-expandable metallic stents. The aim of this study was to evaluate outcomes after placement of conformable covered and uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction.. A single-blind, randomized, parallel-group, prospective study were conducted in 4 medical centres between March 2009 and July 2012. 134 patients with unresectable malignant gastroduodenal obstruction were assigned to a covered double-layered (n=66) or uncovered unfixed-cell braided (n=68) stent placement group. Primary analysis was performed to compare re-intervention rates between two groups.. 120 patients were analysed (59 in the covered group and 61 in the uncovered group). Overall rates of re-intervention were not significantly different between the two groups: 13/59 (22.0%) in the covered group vs. 13/61 (21.3%) in the uncovered group, p=0.999. Stent migration was more frequent in the covered group than in the uncovered group (p=0.003). The tumour ingrowth rate was higher in the uncovered group than in the covered group (p=0.016).. The rates of re-intervention did not significantly differ between the two stents. Conformable covered double-layered and uncovered unfixed-cell braided stents were associated with different patterns of stent malfunction.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Digestive System Neoplasms; Duodenal Obstruction; Female; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Prospective Studies; Prosthesis Failure; Retreatment; Single-Blind Method; Stents

Topics: Alloys; Cholestasis; Colonic Diseases; Constriction, Pathologic; Duodenal Obstruction; Equipment Design; Esophageal Stenosis; Foreign-Body Migration; Humans; Intestinal Atresia; Postoperative Complications; Stents

Duodenal stenting has become a broadly accepted first line of treatment for patients with advanced malignant gastroduodenal obstruction as these patients are difficult to treat and are poor surgical candidates.. To document duodenal stent performance for palliative management of malignant gastroduodenal obstruction.. Multicentre, single arm, prospective registry documenting peroral endoscopic duodenal stenting procedures in 202 patients.. Technical success achieved in 98% (CI, 95%, 99%) of stent placements. Increase of Gastric Outlet Obstruction Score by at least 1 point compared to baseline was achieved in 91% (CI, 86%, 95%) of patients persisting for a median of 184 days (CI, 109, 266). By day 5 (CI, 4, 6) after stent placement, 50% of patients experienced a score increase of at least 1 point. Improvement from 14% of patients at baseline tolerating soft solids or low residue/normal diet to 84% at 15 days, 86% at 30 days, 81% at 90 days, 79% at 180 days, and 70% at 270 days. Complications included stent ingrowth and/or overgrowth (12.4%), transient periprocedural symptoms (3%), bleeding (3%), stent migration (1.5%), and perforation (0.5%).. Safety and effectiveness of duodenal stenting for palliation of malignant gastroduodenal obstruction was confirmed in the largest international prospective series to date.

Topics: Alloys; Duodenal Obstruction; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastric Outlet Obstruction; Gastrointestinal Neoplasms; Humans; Male; Prospective Studies; Prosthesis Design; Registries; Stents; Survival Analysis

The objective of our study was to assess the incidence, predictive factors, and treatment of tumor overgrowth after placement of expandable metallic dual stents in patients with malignant gastroduodenal obstruction.. Expandable metallic dual stents were inserted under fluoroscopic guidance in 583 patients with symptomatic malignant gastroduodenal obstruction. We retrospectively reviewed prospectively collected patient records to determine the incidence and treatment of tumor overgrowth after stent placement and used multivariate analysis to determine factors predicting tumor overgrowth.. Tumor overgrowth occurred after stent placement in 22 of 583 patients (3.8%) (range, 41-634 days; mean, 179.0 days). Duodenal lesions (odds ratio [OR], 4.505; p = 0.002), longer survival time (OR, 1.003; p = 0.001), and length of obstruction (OR, 0.783; p = 0.035) were independent predictors of tumor overgrowth. Twenty of the 22 patients were successfully treated by placement of a second dual stent, whereas the other two patients refused placement of a second stent or other further treatment. Overall, 19 of 20 patients (95%) showed improvement in symptoms after second stent placement. Duodenal perforation occurred in one of the 20 patients 125 days after placement of a second stent and was treated surgically.. Tumor overgrowth seems to be an uncommon complication of expandable metallic dual stent placement in patients with malignant gastroduodenal obstruction. Tumor overgrowth is associated with duodenal lesions, longer survival time, and shorter stricture length. Tumor overgrowth can be successfully managed by coaxial insertion of a second dual-expandable metallic stent into the obstructed first stent.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alloys; Contrast Media; Duodenal Obstruction; Female; Fluoroscopy; Follow-Up Studies; Gastric Outlet Obstruction; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Prosthesis Design; Radiography, Interventional; Retrospective Studies; Stents

The aim of the present study was to investigate the clinical effectiveness, safety, and outcome associated with the use of covered expandable Nitinol stents (Taewoong Medical, Seoul, Korea) for the treatment of malignant gastroduodenal obstructions.. Between March 2001 and October 2004, covered expandable Nitinol stents were placed in 68 consecutive patients under endoscopic and fluoroscopic guidance for the following reasons: gastric carcinoma (n = 49), recurrent carcinoma after partial gastrectomy (n = 7), or another malignant neoplasm involving the duodenum (n = 12).. Technical success was achieved in 60 of the 68 patients (88.2%). After stent placement, mean dysphagia score improved from a mean of 3.5 to 1.2 (P < 0.001). The mean period of primary stent patency was 107.2 days. During follow up (mean 4.4 months; range, 1-15 months), major complications (migration [6], bleeding [3], perforation [1], ingrowth [1], overgrowth [7], fistula [1]) occurred in 19 patients (27.9%), and stent migration occurred in six (8.8%) (proximal migration into the stomach [n = 3], or distal migration [n = 3]). Recurrent dysphagia (mainly due to tumor ingrowth/overgrowth) occurred in eight patients (11.8%).. Covered expandable Nitinol stents appear to offer an effective and feasible palliative therapy in patients with a malignant gastroduodenal obstruction.

Topics: Aged; Alloys; Duodenal Obstruction; Duodenoscopy; Female; Gastric Outlet Obstruction; Gastrointestinal Neoplasms; Gastroscopy; Humans; Male; Middle Aged; Palliative Care; Prosthesis Design; Retrospective Studies; Stents; Time Factors; Treatment Outcome

Metallic stents are a therapeutic option for patients with malignant GI obstruction.. Our purpose was to evaluate the clinical effectiveness of a self-expandable metallic stent in 213 patients with malignant gastroduodenal obstruction and to identify prognostic factors associated with clinical outcomes.. Prospective cohort study.. Single tertiary referral university hospital.. Two hundred thirteen consecutive patients with symptomatic malignant gastric outlet or duodenal obstruction from 2001 to 2005.. Placement of a self-expandable metallic stent.. Prospective data collection focused on technical and clinical success, complications, and prognostic factors associated with stent patency.. Technical and clinical success were achieved in 94% and 94% of the patients, respectively, and the complication rate was 21%. The median and mean survival periods were 99 (95% CI, 78-121) and 159 days (95% CI, 116-203). The median and mean stent patency periods were 270 (95% CI, 234-413) and 324 days (95% CI, 128-412). With use of the multivariate Cox proportional hazard model, chemotherapy after stent placement (odds ratio, 0.19; 95% CI, 0.08-0.46; P < .001) was significantly associated with an increase in the maintenance of stent patency.. Single-center experience and the lack of a control group.. Placement of a self-expandable metallic stent is clinically effective in patients with unresectable gastric outlet or duodenal obstruction. Chemotherapy after stent placement, albeit associated with increased migration rates, is associated with an increase in the maintenance of stent patency.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alloys; Duodenal Obstruction; Endoscopy, Gastrointestinal; Female; Fluoroscopy; Gastric Outlet Obstruction; Gastrointestinal Neoplasms; Humans; Male; Middle Aged; Palliative Care; Stents

To assess the efficacy of fluoroscopic per oral placement of self-expandable nitinol stents in the palliative treatment of malignant duodenal obstructions.. Under fluoroscopic guidance, 82 patients (56 male and 26 female; mean age, 62.3 y) with malignant duodenal obstructions were treated with per oral placement of four types of self-expandable nitinol stents. All patients presented with severe nausea and recurrent vomiting, and their obstructions were inoperable.. Technical success was achieved in 78 of 82 patients (95.1%). After stent placement, food intake capacity improved in 74 of 78 patients (94.9%). Stent migration occurred in one patient 4 days after placement. A covered stent was placed to cover the ampulla of Vater in 15 patients without external biliary drainage; three of them (20%) became jaundiced. During the mean follow-up period of 74.7 days (range, 9-374 d), eight patients developed recurrent obstructive symptoms caused by tumor ingrowth (n=2) or tumor overgrowth (n=6). They were successfully treated by additional stent placement. The primary stent patency rates were 97.0%, 79.8%, and 44.0% at 30-, 90-, and 180 days, respectively (mean patency, 228.2 d; 95% CI, 153.9-302.5).. Fluoroscopic per oral placement of self-expandable nitinol stents is an effective palliative treatment for malignant duodenal obstructions.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Duodenal Neoplasms; Duodenal Obstruction; Female; Fluoroscopy; Humans; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Radiography, Interventional; Stents

Temporary placement of a polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stent was performed to treat a benign anastomotic duodenojejunal stricture that was refractory to repeated balloon dilation procedures. The procedure provided a favorable outcome for the patient and was completed without complications. This result suggests that successful treatment of benign strictures of the gastric outlet or duodenum is possible with use of retrievable stents.

Topics: Adult; Alloys; Barium Sulfate; Coated Materials, Biocompatible; Constriction, Pathologic; Duodenal Obstruction; Female; Humans; Jejunal Diseases; Polytetrafluoroethylene; Stents

To investigate the technical feasibility and clinical effectiveness of a dual expandable nitinol stent in the palliative treatment of malignant gastroduodenal strictures.. The dual stent consisted of two stents, an outer partially covered stent and an inner bare nitinol stent. The outer diameter of the stent delivery system was 3.8 mm. With fluoroscopic guidance, the outer stent was placed into the stricture, followed by coaxial placement of the inner stent. The stent placement was attempted in 102 consecutive patients with malignant gastroduodenal strictures. The underlying causes of malignant strictures were gastric cancer (n = 55), pancreatic cancer (n = 24), gallbladder cancer (n = 7), cholangiocarcinoma (n = 5), duodenal cancer (n = 5), and metastatic cancer (n = 6). All patients presented with symptoms of gastric outlet obstruction.. Stent placement was technically successful and well tolerated in 101 of 102 patients (99%). After stent placement, 85 of the 101 patients (84%) with technical success experienced improvement of their symptoms. Tumor overgrowth occurred in five patients, stent migration in two, mucosal hyperplasia in one, bleeding in one, and jaundice in two. Seventy one of the 101 patients died 5 to 340 days (mean, 71 days) after stent placement from progression of their disease, myocardial infarction, bleeding, or sepsis. The remaining 30 patients are still alive 6 to 227 days (mean, 39 days) after stent placement. The 30-day, 60-day, 90-day, and 180-day survival rates were 78%, 58%, 39%, and 8%, respectively.. The dual stent with a 3.8-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant gastroduodenal strictures.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Constriction, Pathologic; Duodenal Obstruction; Feasibility Studies; Female; Fluoroscopy; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Pilot Projects; Radiography, Interventional; Statistics, Nonparametric; Stents; Survival Analysis; Treatment Outcome

To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions.. The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable.. Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1-4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results.. Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Duodenal Neoplasms; Duodenal Obstruction; Feasibility Studies; Female; Gastric Outlet Obstruction; Humans; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Polyurethanes; Prosthesis Design; Prosthesis Failure; Pyloric Stenosis; Radiography; Stents; Stomach Neoplasms

The authors implanted a duodenal stent in a woman with a high-grade duodenal stenosis due to inoperable tumor compression. A flexible self-expanding knitted nitinol stent that conformed to the shape of the duodenum was introduced orally to keep the duodenal passage patent. After stent implantation, repeated vomiting stopped and the patient was able to eat and drink. This technique resolved the patient's duodenal stenosis.

Topics: Adenocarcinoma; Alloys; Colonic Neoplasms; Constriction, Pathologic; Duodenal Obstruction; Equipment Design; Female; Humans; Middle Aged; Palliative Care; Radiography, Interventional; Stents