Gastrointestinal Luminal Stenting: The Early US Experience with the Duodenal HANAROSTENT

Self-expandable metal stents (SEMSs) are frequently utilized for palliation of malignant gastric and/or duodenal outlet obstruction (GDOO). Re-establishing luminal patency with accurate SEMS positioning while limiting migration and adjacent tissue injury is an important technical consideration and aim. The duodenal HANAROSTENT^® was introduced in the USA in 2019 and developed with these challenges in mind. As the first center in the USA to deploy the duo-denal HANAROSTENT^® in clinical practice, we herein examine our early experience with its use. Specifically, we describe 7 consecutive cases of malignant GDOO in which a duodenal HANAROSTENT^® was placed for on-label use, defined as palliative treatment of malignant gastric and/or duodenal obstruction. All stents were 22 mm in diameter, with 5 being 90 mm and 2 being 120 mm in length. Technical and clinical success with duodenal HANAROSTENT^® placement were achieved in all 7 cases (100%). In no case was stent adjustment required post-deployment. There were no stent-related adverse events, and no subsequent endoscopic procedures were necessary in any of the patients during a mean follow-up of 5 months (range 1-12 months). In summary, the duodenal HANAROSTENT^® appears to perform well and be a promising alternative to other available duodenal SEMSs. As experience in the USA with this newly introduced duodenal SEMS grows, multicenter prospective data should be collected to better establish its relative safety and efficacy.

Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: a randomized prospective study

BACKGROUND

A conformable self-expandable metallic stent was developed to overcome the limitation of previous self-expandable metallic stents. The aim of this study was to evaluate outcomes after placement of conformable covered and uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction.

METHODS

A single-blind, randomized, parallel-group, prospective study were conducted in 4 medical centres between March 2009 and July 2012. 134 patients with unresectable malignant gastroduodenal obstruction were assigned to a covered double-layered (n=66) or uncovered unfixed-cell braided (n=68) stent placement group. Primary analysis was performed to compare re-intervention rates between two groups.

RESULTS

120 patients were analysed (59 in the covered group and 61 in the uncovered group). Overall rates of re-intervention were not significantly different between the two groups: 13/59 (22.0%) in the covered group vs. 13/61 (21.3%) in the uncovered group, p=0.999. Stent migration was more frequent in the covered group than in the uncovered group (p=0.003). The tumour ingrowth rate was higher in the uncovered group than in the covered group (p=0.016).

CONCLUSIONS

The rates of re-intervention did not significantly differ between the two stents. Conformable covered double-layered and uncovered unfixed-cell braided stents were associated with different patterns of stent malfunction.

Gastroduodenal stenting

Palliative procedures for patients with malignant gastroduodenal obstruction must be readily available, have a rapid onset of action, and be well tolerated by a patient with terminal cancer. Laparoscopic gastroenterostomy and insertion of self-expanding stents are emerging as the current methods of choice.An increasing number of dedicated enteral stents with different properties are now available. These can be placed under fluoroscopic guidance alone or with the help of an endoscope. Endoscopic placement has several advantages but requires good collaboration between the endoscopists and the radiology department. Appropriate imaging and work-up of each case at multidisciplinary meetings is required. Coexisting biliary obstruction may be dealt with endoscopically, but frequently requires percutaneous biliary stent placement prior to duodenal stenting. Reintervention is required in up to 25% of patients, usually due to stent occlusion by further tumor growth. This article suggests strategies for patient assessment, procedure planning, and stent insertion.