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. 2022 Dec;54(12):1139-1146.
doi: 10.1055/a-1838-5642. Epub 2022 Apr 28.

Self-expandable duodenal metal stent placement for the palliation of gastric outlet obstruction over the past 20 years

Agnes N Reijm  1 , Pauline A Zellenrath  1 , Ruben D van der Bogt  1 , Lydi M J W van Driel  1 , Peter D Siersema  2 , Marco J Bruno  1 , Manon C W Spaander  1
Affiliations

Self-expandable duodenal metal stent placement for the palliation of gastric outlet obstruction over the past 20 years

Agnes N Reijm et al. Endoscopy. 2022 Dec.

Abstract

Introduction: Duodenal stent placement is a palliative option for management of malignant gastric outlet obstruction (GOO). In the last 20 years, management of gastrointestinal cancers has considerably changed. It is unknown if these changes have affected clinical outcome of duodenal stent placement.

Methods: Retrospective cohort study conducted in a tertiary referral center. Patients who underwent duodenal stent placement for GOO-symptoms due to a malignant stricture were included. Primary outcome was GOO-symptom free survival. Secondary outcomes included stent-related adverse event rates. Potential explanatory parameters such as period of stent placement (1998-2009 vs 2010-2019), prior treatments, peritoneal deposits, and stricture length were evaluated using multivariable Cox regression analysis.

Results: A total of 147 patients (62 % male; median age 64 years) were included. After a median of 28 days after stent placement, 82 patients (57 %) had recurrent GOO-symptoms. GOO-symptom free survival was significantly lower in 2010-2019 (P < 0.01). Time period was the only independent predictor for reduced GOO-symptom free survival (HR 1.76, P < 0.01). Stent-related adverse event rates increased over time (1998-2009: 31 % vs 2010-2019: 37 %). Prior treatment with chemotherapy and/or radiotherapy was significantly associated with an increased risk of adverse events (OR 2.53, P = 0.02).

Conclusions: Clinical outcome of duodenal stent placement did not improve over time. The decreased GOO-symptom free survival and increased adverse event rate in more recent years are probably related to the chemo- and/or radiotherapy treatment provided prior to duodenal stent placement.

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Conflict of interest statement

M. C. W. Spaander has received research support from Medtronic, Norgine, and Boston Scientific. P. D. Siersema has recieved research support from Pentax, The E-Nose company, Lucid Diagnostics, MicroTech, Motus GI, Magentiq Eye and Endo Tools Therapeutics. M. J. Bruno has recieved research support from Boston Scientific, Cook Medical, Pentax Medical, Mylan, Interscope and ChiRoStim.

Figures

Fig. 1
Fig. 1
Graphs showing the rates, overall and in the two time periods, for: a recurrence of gastric outlet obstruction symptoms, with causes; b adverse events, among the 143 patients who underwent successful duodenal stent placement.
Fig. 2
Fig. 2
Survival curves comparing patients treated between 1998–2009 and 2010–2019 for: a gastric outlet obstruction symptom-free survival; b overall survival.
See this image and copyright information in PMC

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