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Covered self-expandable metallic stents in benign pyloric obstruction: long term results

Gokhan Demiral, Onur Bayraktar, Salih Boluk, Alp Ozcelik, Ibrahim Ali Ozemir, Baris Bayraktar

Background/aim: The Self-Expandable Metalic Stent (SEMS) was firstly used for treatment of malignant obstruction of the esophagus, pylorus and colon. Nowadays some recent studies has been documented the use of SEMS in Benign Pyloric Obstruction (BPO). In this study we aimed to evaluate the efficacy of covered SEMSs in BPO.

Method: A total 15 patients hospitalized with BPO and underwent SEMS between June 2012 and May 2016. Data were analysed retrospectively.

Results: Study was consisted of 6 female and 9 male patients with a median age of 55.4 (27-73 y) and follow-up time of 42.7 (27-60 months). SEMS technically applied with success in all patients. BPO was due to peptic ulcer in 6 patients (40%) and peptic ulcer perforation surgery in 9 (60%). Gastric Outlet Obstruction Scoring System (GOSS) was used to assess symptom improvement. Significant symptomatic improvement was observed on 3rd day with GOOSS 3 in twelve patients and GOOSS 2 in three patients after stenting. Also sixth month GOOSS scores were 3 in 12 patients (three patients were operated after stenting). Major complications was observed in four patients (26.7%); stent migration in 2, perforation and bleeding in 1. Minor complications were gastoparesis and dyspepsia in 6 patients, abdominal pain in 2, halitosis in 2 and hematemesis in 1, and severe vomiting in 1. Two patients were symptom free (13.3%). Helicobacter pylori test was positive after stenting and Hp eradication was applied to all patients.

Conclusion: Covered SEMS has the advantages of low complications, rapid improvement in obstructive symptoms and high patient compliance in BPO.