Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1580
Peer-review started: July 24, 2014
First decision: August 15, 2014
Revised: September 3, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: February 7, 2015
AIM: To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.
METHODS: A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.
RESULTS: The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).
CONCLUSION: Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.
Core tip: Malignant duodenal obstruction is a terminal event in patients with pancreatic, hepatobiliary, duodenal, and metastatic cancer. In these patients, maintenance of oral food intake is crucial because it is essential to their quality of life. However, comparison of clinical outcomes between uncovered and covered stent placements have been not well evaluated in malignant duodenal obstruction. Our results show that uncovered stents may be preferable in patients with malignant duodenal obstruction because of their greater resistance to stent migration and longer overall duration of stent patency than those of covered stents.