Korean J Radiol.  2016 Dec;17(6):893-902. 10.3348/kjr.2016.17.6.893.

Efficacy of Retrievable Metallic Stent with Fixation String for Benign Stricture after Upper Gastrointestinal Surgery

• Kim JE
• Kim HC
• Lee M
• Hur S
• Kim M
• Lee SH
• Cho SB
• Kim CS
• Han JK

• KMID: 2466286
• DOI: http://doi.org/10.3348/kjr.2016.17.6.893

Abstract

OBJECTIVE
To determine the efficacy of retrievable metallic stent with fixation string for benign anastomotic stricture after upper gastrointestinal (UGI) surgery.
MATERIALS AND METHODS
From June 2009 to May 2015, a total of 56 retrievable metallic stents with fixation string were placed under fluoroscopy guidance in 42 patients who were diagnosed with benign anastomotic stricture after UGI surgery. Clinical success was defined as achieving normal regular diet (NRD).
RESULTS
The clinical success rate after the first stent placement was 57.1% (24/42). After repeated stent placement and/or balloon dilation, the clinical success rate was increased to 83.3% (35/42). Six (14.3%) patients required surgical revision to achieve NRD. One (2.4%) patient failed to achieve NRD. Stent migration occurred in 60.7% (34/56) of patients. Successful rate of removing the stent using fixation string and angiocatheter was 94.6% (53/56). Distal migration occurred in 12 stents. Of the 12 stents, 10 (83.3%) were successfully removed whereas 2 could not be removed. No complication occurred regarding distal migration.
CONCLUSION
Using retrievable metallic stent with a fixation string is a feasible option for managing early benign anastomotic stricture after UGI surgery. It can reduce complications caused by distal migration of the stent.

Keyword

Stent; Benign stricture; Upper gastrointestinal tract; Stent migration; Fixation string

MeSH Terms

Adult
Aged
Aged, 80 and over
Angioplasty, Balloon
Constriction, Pathologic
Female
Fluoroscopy
Foreign-Body Migration
Gastroenterostomy
Gastrointestinal Diseases/*surgery
Humans
Male
Middle Aged
*Stents
Surgical Fixation Devices
Treatment Outcome

Figure

• 

  Fig. 1 Stent used in this study. It is composed of single thread of 0.1778 mm nitinol wire. It is fully covered with silicone and polytetrafluoroethylene. Both ends of stent are flared. Polyester string is wrapped around proximal end of stent body. Diameter of stent body is 20 mm. Diameter of proximal or distal end is 28 mm.

• 

  Fig. 2 Anterior (A) and oblique (B) view showing how to fix string after stent placement. String outside body is covered by Nelaton tube to reduce pain of nostril and ear. End of string was wound around gauze and anchored around ear using tape to prevent distal migration of stent.

• 

  Fig. 3 58-year-old female who had undergone gastrojejunostomy for gastrointestinal stromal tumor of stomach received repositioning of distally migrated stent. A. 20 × 120 mm retrievable stent with string was placed at anastomotic stricture site. Plain radiography obtained 5 days after stent placement revealed complete distal migration of stent. B. 7F guiding catheter was introduced over string to reach proximal end of migrated stent. C. String was pulled and stent was repositioned proximally with guiding catheter. D. When stent was repositioned at original location, string was released and guiding catheter was removed from body.

• 

  Fig. 4 Clinical outcome of study population. A. Results of 42 initially placed stents. B. Results of 24 migrated initial stents. NRD = normal regular diet, SBD = soft blend diet, Tx = treatment C. Results of 14 repeated stents. NRD = normal regular diet

• 

  Fig. 5 63-year-old man with anastomotic stricture after Billroth I subtotal gastrectomy for gastric lipoma. A. UGI study obtained 8 days after surgery showing segmental narrowing (arrows) at anastomotic site with passage disturbance. B. 20 × 120 mm retrievable stent was placed covering stricture site. C. Stent was removed electively 20 days after placement. Follow-up UGI study obtained after stent removal showed widened previous stricture site (arrows) and good passage of contrast medium. UGI = upper gastrointestinal

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