Incidence and factors associated with stent dysfunction and pancreatitis after gastroduodenal stenting for malignant gastric outlet obstruction

Daiki Yamashige; Susumu Hijioka; Yoshikuni Nagashio; Yuta Maruki; Soma Fukuda; Shin Yagi; Kohei Okamoto; Hidenobu Hara; Yuya Hagiwara; Daiki Agarie; Tetsuro Takasaki; Mark Chatto; Akihiro Ohba; Shunsuke Kondo; Chigusa Morizane; Hideki Ueno; Miyuki Sone; Yutaka Saito; Takuji Okusaka

doi:10.1055/a-2261-2833

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(03): E367-E376
DOI: 10.1055/a-2261-2833

Original article

Incidence and factors associated with stent dysfunction and pancreatitis after gastroduodenal stenting for malignant gastric outlet obstruction

Daiki Yamashige

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Susumu Hijioka

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Yoshikuni Nagashio

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Yuta Maruki

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Soma Fukuda

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Shin Yagi

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Kohei Okamoto

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Hidenobu Hara

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Yuya Hagiwara

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Daiki Agarie

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Tetsuro Takasaki

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Mark Chatto

²Department of Gastroenterology, Makati Medical Center, Makati City, Philippines (Ringgold ID: RIN37571)

,

Akihiro Ohba

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Shunsuke Kondo

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Chigusa Morizane

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Hideki Ueno

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Miyuki Sone

³Department of Diagnostic Radiology, National Cancer Center Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

,

Yutaka Saito

⁴Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Takuji Okusaka

¹Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital Japan, Chuo-ku, Japan (Ringgold ID: RIN13874)

› Author Affiliations

Abstract

Background and study aims Endoscopic gastroduodenal stent (GDS) deployment is currently a standard treatment for malignant gastric outlet obstruction (mGOO) in patients with limited life expectancy; however, stent dysfunction (SD) and complicated pancreatitis often occur after GDS deployment. We investigated incidence and contributing factors of SD and complicated pancreatitis.

Patients and methods We retrospectively reviewed 203 patients who underwent initial GDS deployment for palliation of mGOO symptoms between October 2017 and July 2022, including 109 who underwent GDS deployment across the duodenal papilla (sub-cohort).

Results SDs, including tumor ingrowth (n = 26), kinking (n = 14), and migration (n = 13), occurred in 68 patients (33.5%). Cumulative SD incidence was 41.1% (95% confidence interval, 32.6–49.4%). SD incidence increased to 0.4%, 0.16%, and 0.06% per day at < 8, 8–16, and>16 weeks, respectively. On multivariate analysis, Niti-S pyloric/duodenal stent deployment (sub-distribution hazard ratio [sHR] 0.26, P = 0.01) and survival length ≥ 90 days (sHR 2.5, P = 0.01) were respectively identified as favorable and risk factors significantly associated with SD. Pancreatitis developed in 14 patients (12.8%) in the sub-cohort, which had significantly higher parenchymal diameter (P < 0.01) and lower main pancreatic duct (MPD) caliber (P < 0.01) than the non-pancreatitis cohort. On multivariate analysis, MPD caliber < 3 mm independently predicted pancreatitis (odds ratio 6.8, P = 0.03).

Conclusions Deployment of the Niti-S pyloric/duodenal stent, with conformability even for angulated strictures, significantly reduced the incidence of SD. Stent selection, life expectancy, and MPD caliber should be taken into consideration during decision-making for GDS deployment for mGOO.

Keywords

Endoscopy Upper GI Tract - Malignant strictures - Dilation, injection, stenting - Pancreatobiliary (ERCP/PTCD) - Strictures

Full Text

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Supplementary material