What is the ideal stent as initial intervention for malignant gastric outlet obstruction?

Background: Self-expandable metal stents are effective palliation for malignant gastric outlet obstruction. The aims of study were to evaluate efficacy and safety of double-layered Comvi, uncovered and covered stent to find out protocols which enhance stent patency. Methods: We retrospectively analysed data from 224 patients who underwent endoscopic stent placement for malignant gastric outlet obstruction caused by stomach cancer from 2006 to 2011. Technical and clinical success rates were evaluated and clinical outcomes were compared according to stent types and chemotherapy. Results: The overall technical and clinical success rates were achieved in 99.6% and 80.4%, respectively without immediate complications. The clinical success rate was not significantly different between three groups. The median stent patency time was 156 days [interquartile range 66-279] without differences between groups. The 4-, 8-, and 12-week patency rates were 89.4%, 77.3%, and 61.2%, respectively with no differences between groups. The re-stenosis of stent frequently occurred in the case of the uncovered stents, while migration was more likely to be observed for the covered and Comvi stent. Chemotherapy significantly lowered re-intervention rates, especially in uncovered stents. Conclusions: Patency rates are significantly improved by combining the use of uncovered stent with follow-up chemotherapy treatment, which retains the advantages of the mechanical and chemical aspects of stent and chemotherapy, respectively.