Efficacy of a higher-flexibility duodenal stent for palliation of gastric outlet obstruction

Abstract

Background and study aims: Duodenal self-expandable metallic stent (SEMS) placement is a common palliative treatment for malignant gastric outlet obstruction symptoms (GOOS). The higher flexibility of the WallFlex Duodenal Soft stent aims to ease stent placement and reduce adverse events (AE). This descriptive study compared the WallFlex Soft stent with other duodenal SEMS designs with regard to efficacy and safety.

Patients and methods: Patients receiving the WallFlex Duodenal Soft stent as first-line treatment for GOOS were included in a prospective cohort (2019-2023). A retrospective cohort (1998-2019) with patients treated with other duodenal SEMS designs as first-line treatment for GOOS was used for comparison.

Results: In the prospective cohort, 11 patients were treated with the WallFlex Duodenal Soft, achieving 100% technical and 82% clinical success rates. The retrospective cohort of 147 patients with various types of duodenal SEMS showed 97% technical and 86% clinical success. For the WallFlex Duodenal Soft vs. the other duodenal SEMS, the overall survival was 101 vs. 82 days and median symptom-free survival was 83 vs. 28 days. AE rates were 18% vs. 28%, respectively.

Conclusions: The WallFlex Duodenal Soft stent effectively treats GOOS in palliative patients and seems to be associated with longer symptom-free survival and lower AE rates compared with previous duodenal SEMS designs.

Keywords: Dilation, injection, stenting; Endoscopy Upper GI Tract; Malignant strictures; Performance and complications; Quality and logistical aspects; Reflux disease.

Fig. 1

Design and placement of the WallFlex Duodenal Soft Stent. a WallFlex Soft duodenum stent. b Standard through-the-scope, over-the-wire placement technique. c Deployment of the WallFlex Soft duodenum stent in a patient. ( a and b courtesy of Boston Scientific.)