Preprocedural control of nutritional status score and prediction of early death after percutaneous endoscopic gastrostomy.

Background and Aim: Percutaneous endoscopic gastrostomy (PEG) is often associated with early mortality. We therefore investigated factors associated with early death after PEG. Methods: The present study comprised patients who had undergone PEG between April 2014 and March 2020. Patients were divided into two groups: an early mortality group who died within 1 month of PEG, and a non-mortality group whose clinical course could be followed for more than 1 month after the procedure. Patient background, hematological data, and procedural duration were compared between groups. Results: Univariate analysis identified older age, high blood urea nitrogen (BUN), low prognostic nutritional index (PNI), and high controlling nutritional status (CONUT) score as factors associated with early death after PEG. In multivariate analysis, high CONUT score remained an independent prognostic factor (P = 0.0035). Conclusion: A high CONUT score may be a prognostic factor for early mortality after PEG.

Gastroduodenal Stenting with a Flexible Stent Demonstrates Favorable Clinical Effectiveness despite Gradual Expansion: A Multicenter Prospective Study.

AIMS: This study aimed to evaluate the effectiveness and safety of stenting with a flexible braided self-expandable metal stent (SEMS) for unresectable malignant gastric outlet obstruction (GOO). METHODS: Palliative stenting was prospectively carried out at seven university hospitals between October 2017 and August 2020. All procedures were performed using a flexible branded SEMS of the same brand. The primary endpoint was clinical success rate at 7 days after stenting. Secondary endpoints were procedural success rate, adverse events, recurrent gastric outlet obstruction (RGOO), and patient survival time. RESULTS: Sixty patients were enrolled. The procedural and clinical success rates were 100% and 90%, respectively. RGOO occurred in 15 cases (25%). Adverse events other than RGOO were found in seven cases (12%). The 50% survival time was 75.5 days (range: 52-97 days). Median expansion rates at 1, 3, and 7 days after stenting were 55%, 65%, and 75%, respectively. CONCLUSIONS: A flexible braided stent woven with relatively thin wires was used for malignant GOO. Despite a gradual expansion with slightly lower expansile force, the stent functioned sufficiently well and showed favorable results. Clinical Trials Registry ID: UMIN000029496.

Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?

AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon dilatation (EPLBD) without endoscopic sphincterotomy in a prospective study. METHODS: From July 2011 to August 2013, we performed EPLBD on 41 patients with naïve papillae prospectively. For sphincteroplasty of EPLBD, endoscopic sphincterotomy (EST) was not performed, and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the dilatation as complete. We used a retrieval balloon catheter or mechanical lithotripter (ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic outcome. RESULTS: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and 16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4 mm, and the mean number of stones was 3.0 ± 2.4. Complete stone removal was achieved in 97.5% (40/41) of cases, and ML was used in 12.2% (5/41) of cases. The mean number of sessions required was 1.2 ± 0.62. Pancreatitis developed in two patients and perforation in one. The rate of balloon waist disappearance was 73.1% (30/41). No significant differences were noted in procedure time, rate of complete stone removal (100% vs 100%), number of sessions (1.1 vs 1.3, P = 0.22), application of ML (13% vs 9%, P = 0.71), or occurrence of pancreatitis (3.3% vs 9.1%, P = 0.45) between cases with and without balloon waist disappearance. CONCLUSION: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

Effectiveness of the J-Tip Guidewire for Selective Biliary Cannulation Compared to Conventional Guidewires (The JANGLE Study).

BACKGROUND: Wire-guided cannulation has become a common biliary cannulation technique worldwide. Different guidewires with various tip shapes and materials have been reportedly used for wire-guided cannulation. However, there are apparently no studies reporting changes in the biliary cannulation rate according to the type of guidewire used. AIMS: We evaluated the effectiveness of the J-tip guidewire for biliary cannulation. METHODS: We conducted a prospective, multicenter, controlled study involving patients with a native papilla who required biliary cannulation. We allocated the patients to the J-tip guidewire or angled-tip guidewire groups (groups J and A, respectively). If biliary cannulation was not achieved within 10 min, the GW was changed and cannulation was continued. RESULTS: Groups J and A consisted of 66 and 65 enrolled patients, respectively. The biliary cannulation rate with a single guidewire for the first 10 min was 84.8 % (56/66) for group J and 80.0 % (52/65) for group A. The final success rate for biliary cannulation was 100 % in both groups. The mean times necessary for biliary cannulation were 285.8 and 267.6 s in group J and group A, respectively. The incidence rates of complications (i.e., all mild pancreatitis) were 3.0 % (2/66) and 6.2 % (4/65) in group J and group A, respectively. The mean amylase concentrations were 168.0 and 297.7 IU/L in group J and group A, respectively. There were no significant differences in any results between both groups. CONCLUSION: The biliary cannulation rate of the J-tip guidewire was not significantly different from those of standard guidewires.

Direct peroral cholangioscopy using an ultraslim upper endoscope for biliary lesions.

BACKGROUND: The development of direct peroral cholangioscopy (DPOC) using an ultraslim endoscope simplifies biliary cannulation. The conventional techniques are cumbersome to perform and require advanced skills. The recent introduction of the guidewires and balloons has improved the therapeutic outcomes. Here we describe an effective and easier method for performing DPOC using an ultraslim upper endoscope. METHODS: Indications for DPOC were the presence of stones on follow-up of patients who had previously undergone complete sphincteroplasty, including endoscopic sphincterotomy or endoscopic papillary large balloon dilatation. Fifteen patients underwent DPOC. An ultraslim endoscope was inserted perorally and was advanced into the major papilla. The ampulla of Vater was visualized by retroflexing the endoscope in the distal second portion of the duodenum, and then DPOC was performed using a wire-guided cannulation technique with an anchored intraductal balloon catheter. RESULTS: One patient failed in the treatment due to looping of the endoscope in the fornix of the stomach. Fourteen (93.3%) were successfully treated with our modified DPOC technique. Only one patient (6.7%) experienced an adverse event (pancreatitis) who responded well to conservative management. Residual stones of the common bile duct were completely removed in 3 patients. CONCLUSION: The modified method of DPOC is simple, safe and easy to access the bile duct.

Placement of a triple-layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: a multicenter randomized trial.

BACKGROUND: Usually, uncovered self-expandable metallic stents (SEMS) are used for palliation of malignant gastric outlet obstruction (GOO). A triple-layered covered SEMS is reported to be efficacious, but its performance has not been compared with uncovered SEMS. The present study is the first to compare the efficacy and safety of a triple-layered covered versus uncovered SEMS. PATIENTS AND METHODS: A multicenter randomized study was conducted in two tertiary referral centers, with 62 eligible patients with symptomatic GOO to receive covered (n = 31) or uncovered SEMS (n = 31). The primary endpoint was SEMS patency, and secondary endpoints were success rate and adverse events after complete follow up. RESULTS: Both groups had a technical success rate of 100% and comparable clinical success rates (P = 0.67). There was nostatistically significant difference in stent patency and adverse events between the two groups (P = 0.52 and P = 0.38, respectively). Although the occurrence rate of persistent obstructive symptoms was comparable (P = 0.42), that of recurrent obstructive symptoms was higher in the uncovered group (29% vs 3.6%, P = 0.0125). Patient survival did not differ between groups (P = 0.34). CONCLUSION: There was no statistically significant difference in stent patency, but use of a triple-layered covered SEMS was associated with less frequent stent dysfunction more than 4 weeks after stenting, despite similar short-term outcomes.

Newly designed J-shaped tip guidewire: a preliminary feasibility study in wire-guided cannulation.

AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with naïve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or perforation. RESULTS: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guide-wire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe.

Pseudoaneurysm developed after percutaneous endoscopic gastrostomy: a report of two cases.

Percutaneous endoscopic gastrostomy (PEG) is widely performed. However, despite its widespread use, complications often follow and some of them are life-threatening. We report on two patients who developed pseudoaneurysm after PEG and how the bleeding was stemmed by transcatheter arterial embolization. Case 1 is an 84-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. Blood-laced vomiting, followed by hemorrhagic shock was observed on day 21. Pseudoaneurysm less than 10 mm in diameter was observed in the gastroepiploic artery by urgent percutaneous abdominal angiography. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. Case 2 is an 89-year-old man. PEG by the pull method using One Step Button 24 Fr was performed. On day 28, bleeding from the gastrostomy portion occurred and the patient went into shock. On urgent percutaneous abdominal angiography, pseudoaneurysm ∼5 mm in diameter was detected in the left gastric artery. A microcatheter was advanced selectively and the affected area was embolized by metallic coils and n-butyl cyanoacrylate. In the present two cases, gastrostomies were created in the anterior wall of the mid body portion as suitable for PEG position, but the bleedings occurred because of pseudoaneurysm formation accompanied by damage to the gastroepiploic or the left gastric artery. Those who perform PEG on a regular basis should be aware of the possibility of pseudoaneurysm as a serious adverse event.

Factors associated with delayed gastric emptying in patients with stent placement for malignant gastric outlet obstruction.

BACKGROUND AND STUDY AIMS: Delayed gastric emptying (DGE) is an important factor in determining the clinical outcome in patients with stent placement for malignant gastric outlet obstruction but the factors associated with DGE remain unclear. The aim of this study was to investigate whether clinicopathologic data could be used to identify the factors for DGE in such patients. PATIENTS AND METHODS: A prospective, single-arm, observational clinical study was performed in a referral hospital in Japan. A total of 54 patients with stent placement for malignant gastric outlet obstruction were enrolled. A gastric emptying scintigraphy test was performed 1 week after stent placement. The relationship between DGE and clinicopathologic factors was investigated, and also the relationship between DGE and stent patency time, eating period (when the patient was able to maintain oral intake), and survival time. RESULTS: A total of 38.9 % (21 /54) of patients had DGE. The following were identified as independent predictive factors of DGE: opioid use (odds ratio, 5.32; 95 % confidence interval [95 %CI], 1.07 - 26.41; p = 0.04), chemotherapy before stent placement (odds ratio, 8.03; 95 %CI, 1.85 - 34.95; p = 0.006), and smaller stent diameter (odds ratio, 13.59; 95 %CI, 1.72 - 107.41; p = 0.01). No relationship was found between DGE and the level of oral intake, stent patency time, eating period, and survival time. CONCLUSIONS: The factors associated with DGE after stent placement include those associated with the patient's tumor as well as factors relating to their treatment, including stenting. The clinical and functional results after stent placement appear to be unrelated to the gastric emptying findings.

What is the preferred shape for an esophageal stent flange?

AIM: Self-expandable metallic stents (SEMS) for the gastrointestinal tract have different types of flanges at either the oral end or both ends to prevent stent migration. The effect of flange shape on the properties of SEMS, to our knowledge, has not been evaluated. The aim of this study was to measure the strain that a SEMS imposes on the adjacent wall and the anti-migration force (AF) exerted by three stents, each with a different flange shape. METHODS: Stents with one of three different flanges (flared, dumbbell, and barrel) were designed and then their strain and AF values were measured with apparatuses devised in our laboratory. RESULTS: Although the average maximal strain values at the flange were similar (508.4 µm/m, 513.3 µm/m and 486.4 µm/m for flared, dumbbell and barrel, respectively), strain values for each position differed among the three different types of stents. Strain values for the flared shape increased toward the stent end, reaching the maximum value. Maximal strain values for the dumbbell and barrel shapes were observed near the flange's midpoint. Maximal AF values differed significantly according to flange shape. Thus, the median maximal AF values were 1.85 newton, 1.35 newton, and 1.13 newton, for barrel, dumbbell and flared shapes, respectively. CONCLUSIONS: The performance of braided esophageal SEMS with barrel shaped flanges is superior to that of SEMS with dumbbell or flared flanges, based on the strain on the adjacent wall and the prevention of stent migration.

Comparison of modified introducer method with pull method for percutaneous endoscopic gastrostomy: prospective randomized study.

AIM: The pull method is associated with a high incidence of percutaneous endoscopic gastrostomy (PEG) site infection. The introducer method has been shown to be less likely to cause infection, because it avoids the passage of a tube through the oropharynx. The aim of the present study was to compare the modified introducer method with the pull method for PEG. METHODS: The study included patients who were scheduled for PEG from April 2008 to April 2010. The patients were randomly assigned to receive PEG by the pull method (Group I) or the modified introducer method (Group II). We evaluated the incidence of PEG site infection, some infection-associated parameters and other complications. Wound infections were evaluated in accordance with the Jain's score. RESULTS: Of 62 patients enrolled, 31 patients were assigned to each of the two groups. One patient in Group I died on the day after PEG. The cause of death and relationship with PEG were unclear. Excluding this patient, 61 were included in the per-protocol analysis. The incidence of peristomal infection within 1 week was slightly lower in Group II than in Group I, albeit not statistically significant (12.9% vs 23.3%, P = 0.3354). White blood cell count (WBC) and C-reactive protein (CRP) levels were significantly lower in Group II (WBC: P = 0.0345, CRP: P = 0.0346). None of the patients underwent surgical procedures for the treatment of peristomal infection. CONCLUSION: The results of the present study show that gastrostomy by the modified introducer method may be less likely, although not significantly, to cause peristomal infection than the pull method.

Favorable long-term clinical outcome of uncovered D-weave stent placement as definitive palliative treatment for malignant colorectal obstruction.

BACKGROUND: Most self-expandable metallic stents for colorectal placement are uncovered because of the high migration rate of covered stents. However, the optimal stent design for colorectal use remains unclear. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of a double-wire woven uncovered stent for definitive palliative treatment of malignant colorectal obstruction. DESIGN: This study was a prospective, single-arm, observational clinical study of patients enrolled between December 2005 and September 2010. SETTINGS: This study was conducted at a referral hospital in Japan. PATIENTS: Twenty-four consecutive patients with malignant colorectal obstruction were included in the study. INTERVENTIONS: A double-wire woven uncovered stent was placed by use of a standard through-the-scope endoscopic placement technique. MAIN OUTCOME MEASURES: Technical, initial clinical, and long-term clinical success were measured. Long-term clinical success was defined as sustained relief of obstructive symptoms without reintervention until the patient's death. RESULTS: The Karnofsky performance status score before stent placement was 60 (median, interquartile range, 42.5-67.5). Twenty of 24 patients had primary colorectal cancer, and 4 had extracolorectal malignancies. The site of obstruction was the ascending colon in 10 patients, descending colon in 4 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Technical, initial, and long-term clinical success rates were 100%, 100%, and 83%. Median stent patency time was 149 days (interquartile range, 45-198 days). Median survival time after stent placement was 155 days (interquartile range, 68-231 days). Four patients (17%) had negative outcomes including stent occlusion by tumor ingrowth (8%) and stent migration (8%). The highest Karnofsky performance status score after stent placement was 70 (median; interquartile range, 50-70). The Karnofsky performance status score improved after stent placement (p = 0.002). LIMITATIONS: This study was limited because it was a single-arm, single-center study, and it had a small sample size. CONCLUSIONS: Endoscopic placement of double-wire woven uncovered stents is effective and safe as definitive palliative treatment for patients with malignant colorectal obstruction.

The Effects of Percutaneous Endoscopic Gastrostomy on Quality of Life in Patients With Dementia.

BACKGROUND: To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia. METHODS: We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements. RESULTS: Till October 31st 2010, 1,353 patients with Alzheimer's dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 ± 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia. CONCLUSIONS: These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.

Wire-guided selective cannulation of the bile duct with a sphincterotome: a prospective randomized comparative study with the standard method.

OBJECTIVE: Wire-guided cannulation (WGC) is expected to reduce the incidence of post-ERCP pancreatitis (PEP). Our aim was to compare the incidence of PEP and the success rate of deep biliary cannulation using WGC or the standard cannulation method with contrast injection (STD). MATERIAL AND METHODS: A total of 172 cases with an intact papilla were randomized into the STD group (n = 86) and the WGC group (n = 86). First a trainee endoscopist attempted the cannulation and if it was not successful, an expert endoscopist tried. When the cannulation was not successful within 10 min, the other method was conducted as a second attempt. The primary endpoint was the incidence of PEP and the secondary endpoint was the success rate of selective cannulation. RESULTS: In successful cases, PEP occurred in 6.5% in the STD group and 3.0% in the WGC group in the first attempt. Overall rate of PEP was 6.0% (3, mild; 1, moderate and 1, severe) in the STD group and 2.3% (2, mild) in the WGC group, which were not significantly different. Selective cannulation rate in the first attempt was 73.8% in the STD group and 77.9% in the WGC group. After a crossover, the cannulation was successful in the second attempt in 36.4% and 42.1% and finally in 95.2% and 100% by the STD and WGC method, respectively. CONCLUSIONS: The incidence of PEP tended to be lower in the WGC method compared to the STD method. In addition, all cases of pancreatitis in the WGC group were mild. The success rate of cannulation was comparable between two groups.

Treating bilio-duodenal obstruction: combining new endoscopic technique with 6 Fr stent introducer.

Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer.

Comparison of ultraflex and niti-s stents for palliation of unresectable malignant gastroduodenal obstruction.

AIM: Self-expandable metallic stents are widely used for palliation of malignant gastric outlet obstruction (GOO), but clinical outcomes of different stents have not been compared. Here, we compared outcomes in patients with a GOO receiving either an Ultraflex (UF) or a Niti-S (NS) stent. METHODS: Prospective outcomes in 53 patients receiving palliative placement of an NS stent for symptomatic GOO over a 3-year period were compared with those obtained retrospectively in 31 patients receiving a UF stent in a previous 5-year period. Main outcome measurement was between-group comparison of clinical outcome, complications, and reintervention. RESULTS: Baseline characteristics between the groups were comparable. No difference in technical or clinical success rate was observed. Median procedure time for NS placement was shorter than for UF (15 vs 40 min; P < 0.0001). Complications were more frequent with NS than with UF placement, albeit without statistical significance (16% vs 25%). Although two severe complications occurred in each group, neither was stent related in the NS group. Reintervention was more frequent in the NS group (3% vs 21%; P = 0.0485). Median survival time was 53 versus 88 days for UF versus NS stents, respectively. CONCLUSION: Although no significant difference was seen with regard to feasibility, reintervention was less frequent with UF stents than with NS stents. However, UF stents require much more procedure time, and a complicated and difficult placement procedure. These observations suggest that although NS stents placed using a through-the-scope technique may be more patient friendly than UF stents, further optimization of through-the-scope stents is still required. Further prospective comparison of NS and UF stents in GOO treatment is warranted.

[Successful endoscopic removal of pancreatic catheter after Whipple resection being effective for improving repeated pancreatitis-a case report].

A 54-year-old man had repeated pancreatitis since three years after pylorus-preserving pancreatoduodenectomy (PpPD) and reconstruction by the modified Child method. Since abdominal pain appeared after meals, a pancreatic duct tube was removed endoscopically, which resulted in an improvement. It has been postulated that a pancreatic duct tube, used at the anastomosis between the pancreas and gastrointestinal tract, is spontaneously dislodged or creates a spatial gap with the wall of the main pancreatic duct enough to let the pancreatic juice outflow. However, endoscopic removal of the tube remained in place was significantly effective. We here discussed this case with reference of previous published reports.

Metallic stents for gastric outlet obstruction: reintervention rate is lower with uncovered versus covered stents, despite similar outcomes.

BACKGROUND: Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant gastric outlet obstruction (GOO). A common complication of their use, however, is stent obstruction caused by tumor ingrowth or hyperplasia. The covered SEMS was designed to prevent these problems. OBJECTIVE: We compared the performance of uncovered and covered SEMSs in patients with GOO. DESIGN: A retrospective study, single center. SETTING: A tertiary-referral center. PATIENTS: Sixty patients with symptomatic malignant GOO. INTERVENTIONS: All patients received an uncovered or covered knitted nitinol stent by using the over-the-wire placement procedure. MAIN OUTCOME MEASUREMENT: Comparison of the clinical outcome, complications, and the reintervention rate between uncovered and covered stents. RESULTS: Thirty-one patients (mean [+/-SEM] age 72.2 +/- 2.1 years; 16 men) received uncovered SEMSs, and 29 (mean [+/-SEM] age 70.6 +/- 1.7 years; 17 men) received covered SEMSs. The technical success rate was 100% in both groups. No difference in clinical success was seen (90.3% uncovered group vs 86.2% covered group). Regarding early complications (<1 week), one mild case of pancreatitis from the stent covering the papilla occurred in each group. Late complications included reobstruction, migration, bleeding, stent fracture, and perforation. The occurrence of reobstruction did not differ between the 2 groups (3.2% uncovered group vs 10.3% covered group). No difference in migration (0% uncovered group vs 6.9% covered group) was seen. The uncovered group required less frequent reinterventions for stent reobstruction, migration, or stent fracture (3.2% uncovered group vs 20.7% covered group, P = .0490). The uncovered group had 2 major late complications: bleeding and perforation. All 60 patients died, with a median survival time of 51 days and 62 days, respectively. LIMITATIONS: Small-sized, single-center, retrospective study. CONCLUSIONS: In palliation for malignant GOO, covered stents were associated with a more frequent need for reintervention than uncovered stents, despite similar outcomes and complications. These results require confirmation in a larger randomized comparison.