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DOI: 10.1055/a-2487-2722
Predictive factors for long-term patency in duodenal stenting for malignant gastric outlet obstruction

Abstract
Background and study aims
Malignant gastric outlet obstruction (GOO) occurs often late during disseminated disease, requiring palliation. Placement of duodenal self-expandable metal stents (SEMS) is a common method for relieving malignant GOO but recurrent obstruction is common, warranting reintervention. The aim of the present study was to identify predictive factors for stent patency at 3 months and survival. Also, stent patency rate and adverse events after duodenal stenting were analyzed.
Patients and methods
This was a retrospective observational single-center study including all patients with malignant GOO receiving duodenal SEMS for palliation (2008–2021). Logistic regression for stent patency (3 months) and Cox regression for survival were undertaken.
Results
Overall, 198 patients were included. The most common malignancies were pancreatic adenocarcinoma (40%), gastric adenocarcinoma (18%), and cholangiocarcinoma (13%). Uncovered SEMS were used in 88% of patients and the reintervention rate was 44%. The stent patency rate was 63% in 188 patients with clinical success. Predictors of stent patency at 3 months were jaundice, semi- or fully-covered stents, and chemotherapy prior to stenting. Median survival was 81 days (interquartile range 40–241) after stenting. In Cox regression, predictors for overall survival at 6 months were absence of jaundice and stent patency at 3 months. Stent dysfunction was the most common cause of reintervention and was managed by repeated stent (76%) or dilation (11%).
Conclusions
Treatment of malignant GOO with duodenal SEMS is effective but the reintervention rate is high. Predictors of stent patency were jaundice, semi- or fully-covered SEMS, and chemotherapy. Survival was impaired by jaundice and stent dysfunction.
Keywords
Endoscopy Upper GI Tract - Malignant strictures - Dilation, injection, stenting - Pancreatobiliary (ERCP/PTCD) - Strictures* Shared last authorship.
Publication History
Received: 05 May 2024
Accepted after revision: 25 October 2024
Accepted Manuscript online:
25 November 2024
Article published online:
29 January 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
David Razzaz, Stefan Linder, Alexander Waldthaler, Marcus Holmberg, Poya Ghorbani. Predictive factors for long-term patency in duodenal stenting for malignant gastric outlet obstruction. Endosc Int Open 2025; 13: a24872722.
DOI: 10.1055/a-2487-2722
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