Self-expanding covered metallic stent in the management of malignant gastric stenosis after gastric pull-up operation

Introduction: Following resection of oesophagus and cardia cancer, reconstruction in most cases is achieved by gastric pull-up operation. If the replacement is performed in the posterior mediastinum, the local recidiv tumour can spread onto the pulled up stomach causing stenosis. We treated two such patients with double funnelled, covered metal stents.

Patients and method: Double funnelled, covered gastric prosthesis composed of stainless steal wire, which is connected by polyethylene cover.

Case 1: In a 66 years old patient a distal oesophagectomy and proximal gastrectomy was performed due to cardia tumour and reconstruction was achieved by gastric pull-up operation. Following operation the postvagotomic pylorus stenosis was dilated with a 25–30mm balloon catheter. A year and a half later swallowing difficulties and vomiting recurred. A recidive tumour revealed causing stenosis on the stomach at the level of the diaphragm. This stenosis was treated with a 6cm gastric stent. The patient 6 months after the placement of the gastric stent died due to cachexia.

Case 2: A 52 years old patient underwent subtotal oesophagectomy due to oesophageal tumour. 19 months later he was readmitted for increasing swallowing difficulties. He further complained feeling of fullness after meals, and he has also lost 8–10kg. A CT examination revealed lung metastasis and sub-carinal tumour spreading and an increase in the thickness of the gastric wall. A 3mm in diameter stenosis was detected by endoscopy. The stenosis was treated with a 6cm gastric stent. Due to the procedure swallowing complains and feeling of fullness ceased. The patient 2 years after the primary operation and 3 months following the stent implantation died due to cachexia.

Conclusion: Our gastric stent can successfully be used in the palliative treatment of malignant stenosis developing after gastric pull-up operations.