Objectives: To compare the outcomes of over-the-wire (OTW) and through-the-scope (TTS) partially covered stents in patients with malignant gastric outlet obstruction (GOO).
Methods: A retrospective study was performed in 306 patients who had either OTW (n = 125) or TTS (n = 181) stents placed. Outcomes analysed included technical and clinical success, procedure time, complications, re-intervention, stent patency and survival.
Results: One hundred and ninety-three patients met our inclusion criteria, including 125 patients in the OTW group and 68 patients in the TTS group. Technical and clinical outcomes were similar in the two groups. Stent migration rate was higher in the TTS than in the OTW group (P = 0.002) and was associated with straight stent and subsequent chemotherapy in the TTS group. Stent collapse was lower in the TTS than in the OTW group (P = 0.021). Six-month stent patency rate was higher in the OTW than in the TTS group (P = 0.044).
Conclusions: TTS and OTW stents for the palliation of malignant GOO resulted in similar technical and clinical outcomes, stent patency and survival. TTS stents were associated with a higher migration rate, especially use of straight stents and subsequent chemotherapy, but a lower stent collapse rate than OTW stents.
Key points: • OTW and TTS stents are equally effective in palliating GOO symptoms. • Six-month stent patency was higher for OTW than for TTS. • The straight stent and subsequent chemotherapy could increase stent migration. • Complication rates were lower for flared than for straight stents. • It is necessary to develop a multidisciplinary approach to integrate clinical experience.
Keywords: Dysphagia; Endoscopy; Gastric outlet obstruction; Stents; Stomach neoplasoms.