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Report to the Separate-graft gatroduodenal sents

Report to the Separate-graft gatroduodenal sents migration. Asan medical center. Yang-Hwa Jeong. Background. Problems of bare stents 1. Progressive tumor ingrowth through the wire filaments Problems of covered stents 1. Stent migration

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Report to the Separate-graft gatroduodenal sents

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  1. Report to the Separate-graft gatroduodenal sents migration Asan medical center Yang-Hwa Jeong

  2. Background Problems of bare stents 1. Progressive tumor ingrowth through the wire filaments Problems of covered stents 1. Stent migration 2. Disruption of the covering membranes 3. Large delivery systems (6-mm)

  3. Indication Palliative treatment of malignant gastroduodenal strictures 1. Severe nausea and vomiting 2. Dyspepsia 3. Inoperable malignant gastric outlet and / or duodenal obstructions

  4. Classification AMC : 2001.1 –2004.2 Age : 22 – 86years (mean age, 58) Men : 63 / Women : 39 (total case, 102)

  5. Classification Inoperable cause 1.Extensive tumor growth (n = 42) 2. Presence of distant metastasis (n = 32) 3. Presence of peritoneal seedings (n = 11) 4. Recurrence after surgery (n = 11) 5. Metastatic cancer (n = 6)

  6. Classification Sites of obstruction 1. Stomach (n = 26) 2. Stomach extending to duodenum (n = 29) 3. Duodenum (n = 35) 4. Gastrojejunostomy - Efferent limb - 9 / E&A - 2 (n = 11) 5. Gastric outlet, 2,3rd part of duodenum (n = 1)

  7. Classification Underlying causes of obstructions 1. Gastric cancer (n = 55) 2. Pancreatic cancer (n = 7) 3. Cholangiocarinoma (n = 5) 4. Duodenal cancer (n = 5) 5. Matastatic canacer (n = 6)

  8. Procedure Devices

  9. Stent migration case A Male / 57 1. 01. 7 Stomach ca. 2. 01. 9 G-Dstomy(Billroth 1) 3. 01. 9 –02. 2 (6 months ) RT 4. 03. 8 Recurrence after surgery 5. 03.10 Stent implantation 6. 04. 1 Stent migration 7. In 3 mo. follow up study after migration

  10. Procedure A

  11. Procedure A 1mon F/U

  12. Procedure A 3 mon F/U 4mon F/U

  13. Stent migration case B Male / 59 1. 96. 9 AGC 2. 96.10 EGC Iia+IIc 3. 97. 9 reOP (rotator Caff,rtTear) 4. 03.10 Recurrence after surgery 5. 03.11 Stent implantation 6. 04. 3 Stent migration 7. In 5 mo. follow up study after migration

  14. Procedure B

  15. Procedure B B15mm4cm 1mon F/U

  16. Procedure B 5 mon F/U 6mon F/U

  17. Results Migration rates 1.Bare stent 21-26 % Radiology 2001 2. Polyurethane covered stent 8 % Radiology 2002 3. Separate-graft stent >2 % Radiology 2004

  18. Results Tumor ingrowth 1.Bare stent 3-46 % Radiology 2001 2. Polyurethane covered stent 0-7 % Disruption of membrane 5% Radiology 2002 3. Separate-graft stent 0 % Radiology 2004

  19. Results Survival rates 1.30-day 75 % 2. 60-day 58 % 3. 90-day 39 % 4. 180-day 8 % Radiology 2004

  20. Conclusion Separate-graft gatroduodenal stent system is easy to insert, safe, reasonably effective for palliative treatment malignant gastroduodenal strictures.

  21. Thank you ……

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