How to modify the axis of a self-expandable metal stent to avoid malfunction in gastric outlet obstruction: a simple trick

Malignant gastric outlet obstruction (GOO) is caused mainly by gastric or pancreaticobiliary neoplasms. GOO presents with uncomfortable symptoms, such as nausea, vomiting, and abdominal distension, leading to malnutrition and impaired quality of life [1] [2]. Endoscopic placement of a self‐expandable metal stent (SEMS) is widely accepted as nonsurgical palliative treatment of nonresectable malignant GOO [3]. However, the efficacy of the SEMS can be compromised, especially in patients affected by gastric antral neoplasia, in which GOO relief is not completely obtained. One of the reasons why gastric SEMS can be ineffective is possibly due to the impact of the proximal end of the stent at the great curvature of the gastric body ([Fig. 1 a]).

Fig. 1 Axis of a self-expandable metal stent after its deployment. a Before modification. b After modification by a standard clip.

Four patients who were unfit for surgery underwent SEMS placement for malignant GOO (three women: 25, 52, and 56 years old; and one 57-year-old man). With a standard clip we caught the proximal end of the stent, closing the clip inside the mesh of the body of the SEMS ([Video 1]). This trick modifies the proximal axis of the stent ([Fig. 1 b]), restoring the normal anatomy of the stomach ([Fig. 2]).

Video 1 Modification of the axis of a self-expandable metal stent to avoid malfunction in gastric outlet obstruction.

Fig. 2 X-ray images. a Proximal part of the self-expandable metal stent (SEMS) with the modified axis. b Correct progression of the contrast medium after SEMS modification.

This treatment aims to avoid malfunction of the SEMS by using the clip to modify the axis of the stent and restore the normal anatomy of the stomach.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

• References

• 1 Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am 2011; 21: 389-403
• 2 Tonozuka R, Itoi T, Sofuni A. et al. Endoscopic double stenting for the treatment of malignant biliary and duodenal obstruction due to pancreatic cancer. Dig Endosc 2013; 25 (Suppl. 02) 100-108
• 3 Boskoski I, Tringali A, Familiari P. et al. Self‐expandable metallic stents for malignant gastric outlet obstruction. Adv Ther 2010; 27: 691-703