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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24872722
DOI: 10.1055/a-2487-2722
Original article

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

David Razzaz‡
1   Surgery and Oncology, Capio St Gorans Hospital, Stockholm, Sweden (Ringgold ID: RIN59560)
,
Stefan Linder‡
2   Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
,
Alexander Waldthaler
3   Department of Medicine, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
,
Marcus Holmberg   *
1   Surgery and Oncology, Capio St Gorans Hospital, Stockholm, Sweden (Ringgold ID: RIN59560)
,
Poya Ghorbani   *
2   Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden (Ringgold ID: RIN27106)
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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

Bibliographical Record
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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