An Original Article from the August issue “Individualization of metal stents for management of gastric outlet obstruction caused by distal stomach cancer: a prospective study” by Ding Shi, MM, Yin-su Bao, MM, Yong-pan Liu, MM
Ding Shi, MM, from the First People’s Hospital of Yuhang District, Hangzhou, Zhejiang Province, China, discusses his study “Individualization of metal stents for management of gastric outlet obstruction caused by distal stomach cancer: a prospective study.”
Two basic shapes of gastric outlet obstruction (GOO) caused by distal stomach cancer were observed: cup shaped or approximately cup shaped and funnel shaped or approximately funnel shaped. The maximum breadth of the obstruction cup is mean 51.3mm and the maximum breadth of the obstruction funnel is mean 40.6 mm. But the diameter of the end of standard stents range from 18 to 28mm, which is not suitable for the proximal end of gastric outlet obstruction caused by distal gastric cancer. Individualized stents were designed to be cup shaped or funnel shaped according to the shape and size of the gastric obstruction.
The standard stents may not be suitable for gastric outlet obstruction caused by distal stomach cancer. Because the stomach cavity is wide, the end of the standard stent is too small to cover the lesion of GOO. Moreover, the standard stents have a high incidence of re-obstruction and migration.
A photograph of individualized stents for GOO (A-B: the breadth of the proximal mouth of stents; C: the length of the proximal ends stent). A, a cup stent. B, funnel stent. C, A photograph comparing a 35 mm diameter funnel to a conventional stent.
Covered stents, uncovered stents, double-layer stents, and triple-layer stents encountered several issues, including recurrent obstruction as a result of progressive tumor ingrowth or overgrowth and migration. Not only could the individualized stents cover the lesion of GOO, but they also fit well in the remnant stomach cavity and provided a good pathway for the passage of food and could help reduce tumor ingrowth. The stent design included large proximal ends and distal ends with a diameter of 28mm, which prevented stents from migrating distally and proximally, respectively. Larger, case-control studies are needed to affirm that individualized stents are truly superior to standard ones.
To some extent, individualized stents basically overcame several defects of the standard stents, such as recurrent obstruction as a result of progressive tumor ingrowth and stent migration.
Read the article abstract here.
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