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Report to the Separate-graft Report to the Separate-graft gatroduodenal sents gatroduodenal sents migration migration Asan medical centerAsan medical center
Yang-Hwa JeongYang-Hwa Jeong
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BackgroundBackground
Problems of bare stentsProblems of bare stents 1. Progressive tumor ingrowth through the wire filaments
Problems of covered stentsProblems of covered stents1. Stent migration2. Disruption of the covering membranes 3. Large delivery systems (6-mm)
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IndicationIndication
Palliative treatment of malignant Palliative treatment of malignant ga gastroduodenal stricturesstroduodenal strictures
1. Severe nausea and vomiting 2. Dyspepsia 3. Inoperable malignant gastric outlet
and / or duodenal obstructions
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ClassificationClassification
AMC : 2001.1 –2004.2AMC : 2001.1 –2004.2
Age : 22 – 86years Age : 22 – 86years (mean age, (mean age,
58)58)
Men : 63 / Women : 39 Men : 63 / Women : 39 (( total case, total case,
102)102)
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ClassificationClassification
Inoperable causeInoperable cause 1. Extensive tumor growth ( n = 42 ) 2. Presence of distant metastasis ( n = 32 ) 3. Presence of peritoneal seedings ( n = 11 ) 4. Recurrence after surgery (n = 11 ) 5. Metastatic cancer (n = 6 )
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ClassificationClassification
Sites of obstructionSites of obstruction 1. Stomach (n = 26 ) 2. Stomach extending to duodenum (n = 29 )
3. Duodenum (n = 35 ) 4. Gastrojejunostomy - Efferent limb - 9 / E&A - 2 (n = 11 )
5. Gastric outlet, 2,3rd part of duodenum (n = 1 )
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ClassificationClassification
Underlying causes of obstructionsUnderlying causes of obstructions
1. Gastric cancer (n = 55)2. Pancreatic cancer (n = 7)
3. Cholangiocarinoma (n = 5) 4. Duodenal cancer (n = 5) 5. Matastatic canacer (n = 6)
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Procedure DevicesProcedure Devices
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Stent migration case AStent migration case A Male / 57Male / 57 1. 01. 7 Stomach ca.
2. 01. 9 G-Dstomy(Billroth 1) 3. 01. 9 –02. 2 (6 months ) RT
4. 03. 8 Recurrence after surgery 5. 03.10 Stent implantation 6. 04. 1 Stent migration 7. In 3 mo. follow up study after migration
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Procedure AProcedure A
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Procedure AProcedure A
1mon F/U
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Procedure AProcedure A
4mon F/U3 mon F/U
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Stent migration case BStent migration case B Male / 59Male / 59 1. 96. 9 AGC 2. 96.10 EGC Iia+IIc 3. 97. 9 reOP (rotator Caff,rtTear) 4. 03.10 Recurrence after surgery 5. 03.11 Stent implantation 6. 04. 3 Stent migration 7. In 5 mo. follow up study after migration
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Procedure BProcedure B
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Procedure BProcedure B
1mon F/UB15mm4cm
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Procedure BProcedure B
6mon F/U5 mon F/U
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ResultsResults
Migration ratesMigration rates 1. Bare stent 21-26 % Radiology 2001
2. Polyurethane covered stent 8 % Radiology 200
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3. Separate-graft stent >2 % Radiology 200
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ResultsResults
Tumor ingrowthTumor ingrowth 1. Bare stent 3-46 % Radiology 2001
2. Polyurethane covered stent 0-7 % Disruption of membrane 5% Radiology 200
2 3. Separate-graft stent 0 % Radiology 20
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ResultsResults
Survival ratesSurvival rates 1. 30-day 75 % 2. 60-day 58 % 3. 90-day 39 % 4. 180-day 8 %
Radiology 2004
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ConclusionConclusion
Separate-graft gatroduodenal stent sysSeparate-graft gatroduodenal stent system is easy to insert, safe, reasonably tem is easy to insert, safe, reasonably effective for palliative treatment maligneffective for palliative treatment malignant gastroduodenal strictures.ant gastroduodenal strictures.
Thank you ……
