Malignant Gastric Outlet Obstructions: Treatment by Means of Coaxial Placement of Uncovered and Covered Expandable Nitinol Stents Gyoo-Sik Jung, MD,

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Presentation transcript:

Malignant Gastric Outlet Obstructions: Treatment by Means of Coaxial Placement of Uncovered and Covered Expandable Nitinol Stents Gyoo-Sik Jung, MD, Ho-Young Song, MD, Tae-Seok Seo, MD, Seon-Ja Park, MD, Ja-Young Koo, MD, Jin-Do Huh, MD, Young Duk Chom, MD Journal of Vascular and Interventional Radiology Volume 13, Issue 3, Pages 275-283 (March 2002) DOI: 10.1016/S1051-0443(07)61720-5 Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 1 Photograph of an uncovered stent (top) and a polyurethane-covered retrievable stent (bottom). Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 2 Photograph of a polyurethane-covered retrievable stent shows drawstrings (arrow). The arrowhead indicates the nylon loop. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 3 Gastric carcinoma in a 70-year-old woman. (a) Upper gastrointestinal study performed before stent placement shows stenosis in the antrum of the stomach. (b) Spot radiograph obtained during the procedure shows a sheath (arrows) with a guiding balloon catheter advanced over the guide wire beyond the stenosis. (c) Spot radiograph shows an uncovered stent (arrows) placed throughout the stenosis. (d) A sheath with a guiding balloon catheter was passed over the guide wire through the uncovered stent. (e) Spot radiograph shows a covered stent (arrowheads) during placement in the uncovered stent (arrows) with complete overlap. (f) Upper gastrointestinal study performed 1 day after coaxial placement of the uncovered stent (arrows) and the covered stent (arrowheads) shows good barium flow through the stent. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 4 Gastric carcinoma in a 71-year-old woman. (a) Upper gastrointestinal study performed before stent placement shows stenosis (arrow) in the antrum of the stomach. (b) Upper gastrointestinal study performed 1 day after coaxial stent placement shows partial upward migration of the inner covered stent (arrows). The uncovered stent (arrowheads) is in place. Note the proximal end of the migrated covered stent abutting the wall of the stomach. (c) Spot radiograph obtained while the hooked stent was being pulled out of the stomach shows the collapsed proximal end (arrows) of the covered stent. The arrowhead indicates the uncovered stent. (d) Upper gastrointestinal study performed after placement of a second, covered stent into the first uncovered stent shows good barium flow through the stent (arrows). Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 5 Food intake capacity before (black bars) and after (gray bars) stent placement. Grade 0 = able to tolerate solid food. Grade 1 = able to tolerate soft food. Grade 2 = able to tolerate thick liquids. Grade 3 = able to tolerate water or clear fluids. Grade 4 = unable to tolerate anything perorally. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 6 Gastric carcinoma in a 73-year-old man. (a) Upper gastrointestinal study performed before stent placement shows stenosis in the pyloric portion of the stomach. (b) Upper gastrointestinal study performed 1 day after coaxial stent placement shows good barium flow through the stent (arrows). (c) Upper gastrointestinal study performed 109 days after stent placement shows recurrent stent stenosis (open arrow) caused by tumor ingrowth. (d) Upper gastrointestinal study performed 1 day after placement of a second, covered stent (arrows) shows good barium passage through the stent. (e) Upper gastrointestinal study performed 232 days after the original stent placement shows restenosis (open arrow) distal to the stent (arrows) caused by tumor overgrowth. (f) Upper gastrointestinal study performed 1 day after placement of a third, covered stent (arrows) shows good barium flow. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 7 Graph showing the primary stent patency rate obtained by means of Kaplan-Meier method. Thin lines (above and below) show the upper and lower 95% CI. The curves are dotted after the point at which SE exceeds 10% at 120 days. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions

Figure 8 Graph showing survival rate of patients obtained by means of Kaplan-Meier method. Thin lines (above and below) show the upper and lower 95% CI. SE is <10% to 569 days. Journal of Vascular and Interventional Radiology 2002 13, 275-283DOI: (10.1016/S1051-0443(07)61720-5) Copyright © 2002 Society of Interventional Radiology Terms and Conditions