Palliation of Pyloric Stenosis in Gastric Cancer Using a Combination of Non-Covered and Covered Metallic Stents

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A 62-year-old male presented with appetite loss, abdominal fullness, tarry stool, and vertigo. Gastrointestinal endoscopy showed advanced gastric cancer, type 3, which was diagnosed as poorly differentiated adenocarcinoma with severe pyloric stenosis. Computed tomography (CT) showed hugely enlarged lymph nodes in the para-aortic region. He was diagnosed with gastric cancer stage IV and treated with paclitaxel chemotherapy weekly. However, the treatment was ineffective. A nasogastric tube was required for persistent vomiting with gastric outlet obstruction. We recommended a gastrojejunostomy bypass operation, but the patient refused. After obtaining informed consent, a WallFlex stent was inserted, but did not relieve the obstruction. Endoscopy showed that the stent was obstructed with tumor ingrowth. An UltraFlex covered stent was inserted within the WallFlex stent and was effective. Subsequently, the patient was able to eat solid food for 9 months, received chemotherapy, and died 11 months after stent insertion. Stent therapy should be considered for palliative care in gastric outlet obstruction caused by gastric cancer.