Efficacy of Endoscopic Covered Metal Stenting for Malignant Gastric Outlet Obstruction - Clinical benefit of Endoscopic Covered Metal Stenting

o significant difference was observed between the U-SEMS and C-SEMS groups with respect to technical success, clinical success, GOO score or time to stent dysfunction. Stent migration was significantly more frequent in patients with C-SEMS. Karnofsky performance status, chemotherapy, peritoneal dissemination, and stent underexpansion were associated significantly with poor GOO score improvement in multivariable analyses, but stent type was not. In subgroup analyses, insufficient stent expansion was an independent factor in patients with U-SEMS, but not in C-SEMS. In the insufficient stent expansion subgroup, C-SEMS was associated significantly with superior clinical improvement compared with U-SEMS. Insufficient stent expansion was observed more frequently in patients with gastrointestinal obstruction due to anastomotic sites or metastatic cancer. In conclusion, no clinical difference, apart from stent migration, was observed between patients with U-SEMS and C-SEMS. Gastrointestinal obstruction due to an anastomotic site or metastatic cancer may be an indication for C-SEMS use to improve oral intake after SEMS placement.