Self-expandable metallic stents in malignant gastric outlet obstructions--an alternative approach using modified techniques.

Malignant gastric outlet obstructions are commonly present in an advanced tumor stage. Surgery and other therapy options are often accompanied with substantial problems and reduced quality of life. We therefore investigated the endoscopic palliation with self-expandable metallic stents. This report documents the clinical benefit of new stent systems. During a period of eleven months we implanted eleven self-expandable metallic stents (one Ultraflex Esophageal Stent/five Ultraflex Duodenal Diamond Stents/five Enteral Wallstents) in eight patients with malignant gastric outlet stenoses (five female/three male, average age 66 years, range 42-85 years). The procedure was performed under analgosedation and in seven cases on an outpatient bases. The stenosis could be dilated in all cases without complications, allowing semi-liquid oral feeding at the procedure day. Three patients needed a second stent in the follow-up. Stent dislocation appeared in one case after one month--the stent protruded per vias naturales. The stent struts broke in two patients after one and four months post stent implantation. A new stent could be inserted without complications in both cases. The used products enabled a fast and precise positioning of the metallic stent in malignant gastric outlet stenosis. We experienced some problems with the Ultraflex Duodenal Diamond Stent. This didn't occur with the Enteral Wallstent. Additionally with the Enteral Wallstent we could solve the diamond stent complications. Due to the small diameter (10 French) the Enteral Wallstent system can be positioned wire guided in the stenosis through the working channel of the endoscope. Stent release is performed fluoroscopically and with the use of endoscopic guidance retaining the instrument in the stomach. In our point of view, this metallic stent is an optimal device for the palliative treatment of malignant gastric outlet obstructions.