Report to the Separate-graft gatroduodenal sents

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Report to the Separate-graft Report to the Separate-graft gatroduodenal sents gatroduodenal sents migration migration Asan medical centerAsan medical center

Yang-Hwa JeongYang-Hwa Jeong

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BackgroundBackground

Problems of bare stentsProblems of bare stents 1. Progressive tumor ingrowth through the wire filaments

Problems of covered stentsProblems of covered stents1. Stent migration2. Disruption of the covering membranes 3. Large delivery systems (6-mm)

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IndicationIndication

Palliative treatment of malignant Palliative treatment of malignant ga gastroduodenal stricturesstroduodenal strictures

1. Severe nausea and vomiting 2. Dyspepsia 3. Inoperable malignant gastric outlet

and / or duodenal obstructions

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ClassificationClassification

AMC : 2001.1 –2004.2AMC : 2001.1 –2004.2

Age : 22 – 86years Age : 22 – 86years (mean age, (mean age,

58)58)

Men : 63 / Women : 39 Men : 63 / Women : 39 (( total case, total case,

102)102)

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ClassificationClassification

Inoperable causeInoperable 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 )

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ClassificationClassification

Sites of obstructionSites 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 )

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ClassificationClassification

Underlying causes of obstructionsUnderlying 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)

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Procedure DevicesProcedure Devices

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Stent migration case AStent migration case A Male / 57Male / 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

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Procedure AProcedure A

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Procedure AProcedure A

1mon F/U

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Procedure AProcedure A

4mon F/U3 mon F/U

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Stent migration case BStent migration case B Male / 59Male / 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

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Procedure BProcedure B

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Procedure BProcedure B

1mon F/UB15mm4cm

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Procedure BProcedure B

6mon F/U5 mon F/U

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ResultsResults

Migration ratesMigration rates 1. Bare stent 21-26 % Radiology 2001

2. Polyurethane covered stent 8 % Radiology 200

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3. Separate-graft stent >2 % Radiology 200

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ResultsResults

Tumor ingrowthTumor ingrowth 1. Bare stent 3-46 % Radiology 2001

2. Polyurethane covered stent 0-7 % Disruption of membrane 5% Radiology 200

2 3. Separate-graft stent 0 % Radiology 20

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ResultsResults

Survival ratesSurvival rates 1. 30-day 75 % 2. 60-day 58 % 3. 90-day 39 % 4. 180-day 8 %

Radiology 2004

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ConclusionConclusion

Separate-graft gatroduodenal stent sysSeparate-graft gatroduodenal stent system is easy to insert, safe, reasonably tem is easy to insert, safe, reasonably effective for palliative treatment maligneffective for palliative treatment malignant gastroduodenal strictures.ant gastroduodenal strictures.

Thank you ……