Predictive factors for long-term patency in duodenal stenting for malignant gastric outlet obstruction

Background: Malignant gastric outlet obstruction (GOO) occurs often late during disseminated disease needing palliation. Placement of duodenal self-expandable metal stents (SEMS) is a common method 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 three months and survival. Also, stent patency rate and adverse events after duodenal stenting were analyzed. Methods: 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 malignancy was pancreatic adenocarcinoma (40%), gastric adenocarcinoma (18%) and cholangiocarcinoma (13%). Uncovered SEMS were used in 88%, and the reintervention rate was 44%. The stent patency rate was 63% in 188 patients with clinical success. Predictors for stent patency 3 months were jaundice, semi- or fully covered stents, and chemotherapy prior to stenting. Median survival was 81 days (IQR 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%). Discussion: Treatment of malignant GOO by duodenal SEMS is effective but the reintervention rate is high. Predictors for stent patency were jaundice, semi- or fully covered SEMS, and chemotherapy. Survival was impaired by jaundice and stent dysfunction.

Publication History

Received: 05 May 2024

Accepted after revision: 25 October 2024

Accepted Manuscript online:
25 November 2024