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Over-the-wire versus through-the-scope stents for the palliation of malignant gastric outlet obstruction: A retrospective comparison study

  • Interventional
  • Published:
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Abstract

Objectives

To compare the outcomes of over-the-wire (OTW) and through-the-scope (TTS) partially covered stents in patients with malignant gastric outlet obstruction (GOO).

Methods

A retrospective study was performed in 306 patients who had either OTW (n = 125) or TTS (n = 181) stents placed. Outcomes analysed included technical and clinical success, procedure time, complications, re-intervention, stent patency and survival.

Results

One hundred and ninety-three patients met our inclusion criteria, including 125 patients in the OTW group and 68 patients in the TTS group. Technical and clinical outcomes were similar in the two groups. Stent migration rate was higher in the TTS than in the OTW group (P = 0.002) and was associated with straight stent and subsequent chemotherapy in the TTS group. Stent collapse was lower in the TTS than in the OTW group (P = 0.021). Six-month stent patency rate was higher in the OTW than in the TTS group (P = 0.044).

Conclusions

TTS and OTW stents for the palliation of malignant GOO resulted in similar technical and clinical outcomes, stent patency and survival. TTS stents were associated with a higher migration rate, especially use of straight stents and subsequent chemotherapy, but a lower stent collapse rate than OTW stents.

Key Points

• OTW and TTS stents are equally effective in palliating GOO symptoms.

• Six-month stent patency was higher for OTW than for TTS.

• The straight stent and subsequent chemotherapy could increase stent migration.

• Complication rates were lower for flared than for straight stents.

• It is necessary to develop a multidisciplinary approach to integrate clinical experience.

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Abbreviations

ECOG:

Eastern Cooperative Oncology Group

GOO:

Gastric outlet obstruction

GOOSS:

Gastric Outlet Obstruction Scoring System

OTW:

Over-the-wire

SEMS:

Self-expandable metal stent

TPN:

Total parenteral nutrition

TTS:

Through-the-scope

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Acknowledgements

The scientific guarantor of this publication is Ho-Young Song, M.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This research was supported by the Basic Science Research Program through the National Research Foundation of Republic of Korea (NRF), funded by the Ministry of Science, ICT and Future Planning (NRF-2014R1A2A2A04006562). Sung-Cheol Yun, Ph.D. kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise.

Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported.

Methodology: retrospective, observational, performed at one institution.

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    Authors and Affiliations

    1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea

      Jung-Hoon Park, Ho-Young Song, Jin Hyoung Kim & Jiaywei Tsauo

    2. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea

      Jeong Hoon Lee, Kee Don Choi & Do Hoon Kim

    3. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea

      Min-Hee Ryu

    4. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea

      Sung-Cheol Yun

    5. Department of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea

      Moon-Won Yoo & Dae Wook Hwang

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    1. Jung-Hoon Park
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    Correspondence to Ho-Young Song.

    Additional information

    Jung-Hoon Park and Jeong Hoon Lee contributed equally to this work.

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    Park, JH., Lee, J.H., Song, HY. et al. Over-the-wire versus through-the-scope stents for the palliation of malignant gastric outlet obstruction: A retrospective comparison study. Eur Radiol 26, 4249–4258 (2016). https://doi.org/10.1007/s00330-016-4289-3

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    • DOI: https://doi.org/10.1007/s00330-016-4289-3

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