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Li TF, Fu PJ, Han XW, Ma J, Zhu M, Li Z, Ren JZ. Repeated balloon dilatation with long-term biliary drainage for treatment of benign biliary-enteric anastomosis strictures: A STROBE-compliant article. Medicine (Baltimore) 2020; 99:e22741. [PMID: 33126311 PMCID: PMC7598877 DOI: 10.1097/md.0000000000022741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ± 0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ± 1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.
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Affiliation(s)
- Teng-Fei Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Pei-Ji Fu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xin-Wei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ming Zhu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University
- Interventional Institute of Zhengzhou University, Zhengzhou, China
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Endoscopic stenting for palliation of intra-abdominal gastrointestinal malignant obstruction: predictive factors for clinical success. Eur J Gastroenterol Hepatol 2018; 30:1033-1040. [PMID: 29851864 DOI: 10.1097/meg.0000000000001178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic stenting proved to be a safe alternative to surgery for malignant intra-abdominal gastrointestinal obstruction. Although high technical success rates have been reported, some patients do not experience relief in symptoms. AIM This study aimed to analyse the factors predicting the effectiveness of stent placement in patients with gastrointestinal obstruction. PATIENTS AND METHODS A retrospective study was carried out including 160 patients who underwent palliative stenting for intra-abdominal obstruction in a tertiary centre from December 2012 to July 2017. Technical and clinical success, stent dysfunction and adverse events were analysed. RESULTS The rate of technical success was 98%. The rate of early clinical success was 69 and 81% in upper and lower gastrointestinal obstructions, respectively (P=0.107). In the upper tract, obstruction caused by carcinomatosis was the only independent factor predicting early and late clinical failure [odds ratio (OR): 9.7, 95% confidence interval (CI): 2.5-38.4, P=0.001 and OR: 7.6, 95% CI: 1.8-31.9, P=0.006, respectively]. In the colon, Eastern Cooperative Oncology Group score of at least 3 was an independent factor for early clinical failure (OR: 29.8, 95% CI: 1.9-464.9, P=0.002) and obstruction caused by carcinomatosis was an independent factor for late clinical failure (OR: 14.4, 95% CI: 1.7-119.6, P=0.013). Perforation occurred in 4 patients (2.5%) and stent dysfunction occurred in 15% of patients (4% stent migration; 9% restenosis). Carcinomatosis was a risk factor for perforation (P=0.039) and migration was higher with shorter 6 cm stents (P=0.044). CONCLUSION Stents are effective and safe for palliation of intra-abdominal obstruction. Carcinomatosis predicts an unfavourable clinical outcome. Palliative stenting as an option should be weighed carefully in these patients.
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Bektaş H, Gürbulak B, Düzköylü Y, Çolak Ş, Gürbulak EK, Çakar E, Bayrak S. Clinical Outcomes of Upper Gastrointestinal Stents and Review of Current Literature. JSLS 2017; 21:JSLS.2017.00058. [PMID: 29162972 PMCID: PMC5683815 DOI: 10.4293/jsls.2017.00058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The self-expandable metal stent (SEMS) is an alternative for several possible surgical and palliative treatments of upper gastrointestinal obstructions that occur in several disease states. The present study was performed to describe a single-center experience with upper gastrointestinal stents. METHODS All patients at a single center who had an SEMS placed for the treatment of obstruction over a 3-year period were retrospectively evaluated. Pre- and postoperative dysphagia scoring was calculated and used to evaluate postprocedure improvement in quality of life. Procedural success and early and late complication rates were investigated. RESULTS A total of 171 endoscopic procedures were performed in 73 patients. Procedural success was 95.8% (n = 69) and dilatation was performed in 80 patients. The rate of perioperative complication was 26% (n = 19). After 1 month, stents were patent in all patients (n = 73). Stent obstruction was noted in 6 patients: 2 each at 2, 7, and 10 months. CONCLUSION SEMS usage for palliative and curative purposes in benign or malignant upper gastrointestinal system obstructions is an efficient and reliable treatment method with advantages, such as shortening hospital stay, decreased pain, cost-effectiveness, and low mortality-morbidity rates when compared to surgical procedures, and a high rate of clinical success.
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Affiliation(s)
- Hasan Bektaş
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Bünyamin Gürbulak
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Yiğit Düzköylü
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Şükrü Çolak
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Esin Kabul Gürbulak
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Çakar
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Savaş Bayrak
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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Park JH, Tsauo J, Song HY. Self-expandable metal stent placement for recurrent cancer in a surgically-altered stomach. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiaywei Tsauo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Li TF, Wu G, Han XW, Shui SF, Ren JZ, Li Z, Ren KW. Application of Y-shaped, coated self-expandable metallic stents for anastomotic stenosis after gastrojejunostomy (Billroth II). Acta Radiol 2017; 58:41-45. [PMID: 26924836 DOI: 10.1177/0284185116633909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anastomotic stenosis is an infrequent but life-threatening complication after gastrojejunostomy (Billroth II). Tubular or single tubular stents have limited efficacy due to the particular anatomy. PURPOSE To assess the feasibility of a Y-shaped, fully-coated, self-expandable, metallic stent (SEMS) for anastomotic stenosis after gastrojejunostomy (Billroth II). MATERIAL AND METHODS Between January 2008 and August 2014, 14 patients (10 with gastric carcinoma and four with duodenal ulcers) had anastomotic stenoses following Billroth II reconstructions. Eight patients with gastric cancer had tumor recurrence near the anastomosis; two had benign strictures. The four duodenal ulcer patients had benign stenoses. An integrated Y-shaped, fully coated SEMS was designed to accord with the anatomy of residual gastrojejunal anastomotic strictures. Fourteen stents were inserted under fluoroscopic control. Follow-up was at 1, 3, 9, and 12 months, and then annually. RESULTS All 14 stents were inserted successfully at the first attempt with a technical success rate of 100%. After stenting, abdominal symptoms resolved in all patients. All patients were followed up for 4-27 months (mean, 13.9 months). One of the eight recurrent cases died of multiple tumor metastases and liver failure after 7 months, without obstruction symptoms. In all six patients with benign anastomotic stenosis, the stents were removed successfully without complication and with no evidence of restenosis based on clinical evaluation and imaging. CONCLUSION A Y-shaped, fully-coated SEMS proved to be a feasible and minimally invasive procedure for treating anastomotic stenosis after gastrojejunostomy (Billroth II).
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Affiliation(s)
- Teng-Fei Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Gang Wu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Xin-Wei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Shao-Feng Shui
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Zhen Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
| | - Ke-Wei Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
- Interventional Institute of Zhengzhou University, Zhengzhou, PR China
- Interventional Therapy and Clinical Research Center of Henan Province, Zhengzhou, PR China
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Jee SR, Cho JY, Kim KH, Kim SG, Cho JH. Evidence-based recommendations on upper gastrointestinal tract stenting: a report from the stent study group of the korean society of gastrointestinal endoscopy. Clin Endosc 2013; 46:342-54. [PMID: 23964331 PMCID: PMC3746139 DOI: 10.5946/ce.2013.46.4.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 12/16/2022] Open
Abstract
Endoscopic stents have evolved dramatically over the past 20 years. With the introduction of uncovered self-expanding metal stents in the early 1990s, they are primarily used to palliate symptoms of malignant obstruction in patients with inoperable gastrointestinal (GI) cancer. At present, stents have emerged as an effective, safe, and less invasive alternative for the treatment of malignant GI obstruction. Clinical decisions about stent placement should be made based on the exact understanding of the patient's condition. These recommendations based on a critical review of the available data and expert consensus are made for the purpose of providing endoscopists with information about stent placement. These can be helpful for management of patients with inoperable cancer or various nonmalignant conditions in the upper GI tract.
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Affiliation(s)
- Sam Ryong Jee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Konishi T, Takiguchi N, Soda H, Nagata M, Nabeya Y, Ikeda A, Kainuma O, Cho A, Yamamoto H, Miyazaki M. Examination of the Resection Margin Involvement after Gastrectomy for Gastric Cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.5833/jjgs.2012.0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Gastrointestinal (GI) stent has been developed for palliation of obstructive symptoms in various diseases causing obstruction of GI tract. Self-expanding metal stent (SEMS) has replaced old type of plastic stent, and endoscopic insertion of stent has replaced fluoroscopy-guided insertion. Nowadays, newly-designed SEMSs have been developed for prevention of complications such as stent migration and re-obstruction, and indications of stent recently have been widened into benign conditions as well as malignant obstruction. In this review, the types, method of insertion, indications and clinical outcomes of stent in the upper GI tract would be discussed.
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Affiliation(s)
- Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Gastrointestinal stents offer a feasible, safe, cost effective, and minimally invasive method for reestablishing luminal patency. Previous clinical reports and systematic reviews have demonstrated the role of enteral stents in both the upper and lower gastrointestinal tract. Over the last two decades, the rapid development of deep enteroscopy in concert with the evolution of various stent devices/deployment mechanisms has enabled placement of enteral stents in the mid-gut; hence this has been increasingly reported. The present article focuses on stenting in the mid-gut, a relatively novel term, referring to the small bowel between the ampulla and the ileocecal valve. RECENT FINDINGS Mid-gut stenting is technically more difficult than stenting in the upper and lower gastrointestinal tract, and therefore requires particular expertise, restricting its widespread utility. In total, 86 reported cases involving mid-gut stent deployment, by either endoscopic approaches (80.2%) or percutaneous approaches (19.8%), have been published. Although limited, these results have demonstrated that mid-gut stenting is reliable, effective, and a minimally invasive method for palliating malignant obstruction, as well as sealing leaks and fistulae. SUMMARY This article reviews the current status of mid-gut stenting, including endoscopic technique. The article also speculates about the potential for future advances within this field.
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Placement of a Covered Expandable Metallic Stent to Treat Nonanastomotic Malignant Jejunal Obstructions After Total Gastrectomy With Esophagojejunostomy. AJR Am J Roentgenol 2012; 198:1203-7. [DOI: 10.2214/ajr.11.7419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Kondo J, Taki Y, Terashima M. Influence of a positive proximal margin on oral intake in patients with palliative gastrectomy for far advanced gastric cancer. World J Surg 2011; 35:1030-4. [PMID: 21384243 DOI: 10.1007/s00268-011-1018-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection margin involvement is one of the most significant risk factors for local recurrence in curative gastrectomy, and local recurrence results in anastomotic stenosis. In the present study, the effects of a positive resection margin in palliative gastrectomy on the symptoms of anastomotic stenosis and the amount of oral intake were analyzed. METHODS Between September 2002 and December 2009, 2,228 patients underwent resection for gastric cancer at Shizuoka Cancer Center, Japan, of whom 18 underwent palliative gastrectomy with a positive proximal margin because of urgent symptoms such as tumor bleeding, stenosis, or perforation. These 18 patients were analyzed retrospectively in this study. RESULTS Twelve patients had a positive proximal margin, and six patients had both proximal and distal margin involvement. Anastomotic leakage occurred in 2 patients. The median overall survival was 7.5 months, and the median time from operation to a decrease in oral intake was 5.5 months. Anastomotic recurrence developed in 3 patients, and in all of them, anastomotic stricture was found 2-3 months after gastrectomy. One of these patients, who was in good general condition, was treated by endoscopic balloon dilatation. The other 2 patients did not undergo balloon dilatation because their general condition was poor, with peritonitis carcinomatosa. CONCLUSIONS It does not appear necessary for palliative gastrectomy to achieve a negative proximal margin, because salvage therapies resulted in maintaining a tolerable oral intake in patients who were in good general condition.
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Affiliation(s)
- Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Wu G, Li YD, Han XW, Ding PX. An integrated, self-expanding, Y-shaped, metallic stent for patients with complex obstruction after gastrojejunostomy (Billroth II): initial experience. Radiol Med 2011; 116:759-65. [DOI: 10.1007/s11547-011-0667-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 06/14/2010] [Indexed: 12/19/2022]
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Kim J, Choi IJ, Kim CG, Lee JY, Cho SJ, Park SR, Lee JH, Ryu KW, Kim YW, Park YI. Self-expandable metallic stent placement for malignant obstruction in patients with locally recurrent gastric cancer. Surg Endosc 2010; 25:1505-13. [PMID: 20976484 DOI: 10.1007/s00464-010-1426-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 09/27/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Self-expandable metallic stents (SEMSs) provide effective palliation for inoperable malignant gastric outlet obstruction (GOO). The objective of this study was to evaluate the effectiveness of SEMSs in patients with recurrent gastric cancer after radical gastrectomy. METHODS We retrospectively analyzed data from patients with gastric cancer who underwent endoscopic SEMS placement. The patients had obstructive symptoms due to recurrent gastric cancer after curative-intent subtotal or total gastrectomies. Technical and clinical success rates of stent placement were evaluated and clinical outcomes were compared according to operation types. RESULTS A total of 15 patients underwent total gastrectomies with esophagojejunostomies and Roux-en-Y reconstructions, 8 underwent subtotal gastrectomies with Billroth I reconstructions, and 12 underwent subtotal gastrectomies with Billroth II reconstructions. Four patients in the Billroth II group received stents in afferent and efferent loops, so a total of 39 stents were placed. Technical success was achieved with 92% (36/39) of stents, and clinical success occurred with 90% (35/39) of stents, with no significant differences among surgery groups or between stent types (covered vs. uncovered). The GOO score (preprocedure: 0.45±0.62) increased by 1 week (2.06±0.51, p<0.001) and was maintained up to 1 month (1.71±1.15, p<0.001 compared with initial score). Complications occurred with 17 of 39 stents (44%) and included 2 perforations, 3 migrations, and 12 restenoses. Median stent patency duration was 10.7 weeks and median survival was 21.3 weeks; these did not significantly differ by surgery group (p=0.25 and 0.93, respectively) or stent type (covered vs. uncovered, p=0.51 and 0.96, respectively). CONCLUSION Endoscopic SEMS placement for obstruction due to recurrent cancer after total or subtotal gastrectomy is feasible and provides effective short-term palliation, independent of the type of surgical procedure or stent (covered vs. uncovered) used.
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Affiliation(s)
- Jaihwan Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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