Covered self-expandable metal stents (sems) as a new treatment option for perforated duodenal ulcer

Introduction: Surgical closure is the gold standard for treating perforated duodenal ulcers. Covered self-expandable metal stents are currently used for treating anastomotic leakages. In analogy with this treatment we started to use covered SEMS to treat perforated duodenal ulcers.

Aims & methods: From 2009 to 2012 eight patients (age 62 to 87, six female, two male) with a perforated duodenal ulcer were treated with a covered duodenal SEMS at our surgical department. A covered Hanaro stent (through the scope) from M.I tech Korea was used. It was placed through the endoscope under fluoroscopic and endoscopic guidance. All patients presented with acute epigastric pain and a CT-scan showed intra-abdominal gas. The two first patients were primarily treated with open surgical closure, but due to continuous leakage endoscopic stenting was performed. The six following patients were treated with SEMS as primary treatment due to co-morbidities. Of these patients, one had a complicated ulcer disease with bleeding and had been treated with endovascular coiling previous to the perforation. Another patient who also had been treated with coiling developed a pyloric stenosis and perforated during dilatation. Abdominal drainage was placed percutaneously in four patients. The two patients who were primarily operated received a drainage-tube at the operation.

Results: The patients were treated with SEMS 1 to 36 days after presenting with epigastric pain. Six patients were checked with a CT-scan 1–6 days after stenting showing no leak? ages. One patient with dementia showed good recovery and was not checked for leakage. One patient, 87 years old, died 1 day after stenting. She was in a poor condition due to delayed diagnosis and treatment. In total seven patients recovered without further complications or treatments. All stents were removed endoscopically after a mean of 30 days. These patients are still alive after 6–52 months.

Conclusion: Covered metal stents can safely be used as a treatment of perforated duodenal ulcers. In the future, stent treatment might become a primary option together with percutaneous drainage as an alternative to surgery.