Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer

AIM： To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a selfexpandable metal stent （SEMS） for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS： The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary＇s Hospital, were reviewed retrospectively. RESULTS： Twenty patients （15 male, mean age 63 years） were included. The operations were a total gastrectomy with esophagojejunostomy （n = 12）, subtotal gastrectomy with Billroth-Ⅰ reconstruction （n = 2） and subtotal gastrectomy with Billroth- Ⅱ reconstruction （n = 8）. The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients （15%） within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-Ⅱ reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d （range, 5-439 d）. The median survival was 83 d （range, 12-439 d）. CONCLUSION： Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer, A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.