Significance of Stent Abutment in Gastroduodenal Stent Placement for Gastric Outlet Obstructions.

ABSTRACT

PURPOSE: To evaluate the frequency, severity, and clinical significance of stent abutment (SA) after gastroduodenal stent placement in patients with gastric outlet obstruction caused by unresectable gastric cancer. MATERIALS AND METHODS: A retrospective study was conducted in a single tertiary referral university hospital to identify the incidence and clinical significance of SA in 318 patients who underwent self-expandable metallic stent placement. SA was defined as abutment of the distal end of the stent to the duodenal wall and/or superior duodenal flexure. The outcomes included technical and clinical success, complications, repeat intervention, stent patency, and survival. RESULTS: A total of 318 patients, 107 with SA (33.6%) and 211 without, were included. SA occurred partially (n = 64; 59.8%) and completely (n = 43; 40.2%). The technical and clinical outcomes and survival were similar in the groups with and without SA. Food impaction and resultant repeat intervention rates were higher in the SA group than in the non-SA group (P < .001 and P < .001, respectively), and were associated with complete SA (P = .007). Stent patency rate was lower in the SA group than in the non-SA group (P = .003). CONCLUSIONS: SA was associated with increased food impaction, resulting in a greater incidence of stent malfunction and shorter stent patency compared with a lack of SA. The concept of SA may be useful for the improvement of stent patency and avoidance of food impaction.