Outcomes of duodenal stenting: Experience in a French tertiary center with 220 cases

Ratone, Jean‐Philippe; Caillol, Fabrice; Zemmour, Christophe; Bories, Erwan; Pesenti, Christian; Lestelle, Valentin; Godat, Sébastien; Hoibian, Solène; Proux, A.; Capodano, Géraldine; Giovannini, Marc

doi:10.1016/j.dld.2019.06.025

Cited by 13 publications

(7 citation statements)

References 30 publications

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“…In a larger study by Oh et al 3 (292 patients), post-stent placement survival was similar between patients with pancreatic and non-pancreatic cancer (2.7 vs. 2.4 months). A recent study from a French cancer center, including patients with various cancer types, also revealed a poor prognosis of four months after DS placement 17 . Although endoscopic DS placement itself is a safe procedure and tends to be the first-line treatment for malignant GOO, endoscopists should recognize that GOO is still a poor prognostic marker for patients with cancers, regardless of origin, in the era of advancement of oncological treatment.…”

Section: Discussionmentioning

confidence: 96%

“…The stricture site D3 was another significant favorable factor for prolonged OS after DS placement, which was the new finding in the present study. For patients with malignant GOO, the stricture site was divided into three or four portions, D1, D2, D3, and D4, in the previous studies 14 , 15 , 17 , 23 . However, it has not been clarified whether prognosis depends on the stricture site.…”

Section: Discussionmentioning

confidence: 99%

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The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction

Takamatsu

Fujimori

Miyagahara

et al. 2022

Sci Rep

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Endoscopic duodenal stent (DS) placement for malignant gastric outlet obstruction (GOO) is rapidly increasing in clinical practice; however, the most suitable patient candidates for DS placement have not been determined. One hundred and thirty-five patients with GOO who underwent DS placement in three Japanese referral centers between January 2010 and October 2019 were retrospectively evaluated. Overall survival (OS) after DS placement, technical/clinical success rates, adverse events, and predictive factors affecting OS after DS placement were also analyzed. The median OS after DS placement of all patients was 81 (7–901) days. Technical and clinical success rates were 99.3% and 83.7%, respectively. The GOO Scoring System score significantly increased before and after DS placement (0.9 vs. 2.7, P < 0.001). The procedure-related complication rate was 6.0%. All 19 patients (14.1%) with stent occlusion underwent endoscopic re-intervention successfully. Multivariate analyses revealed chemotherapy after DS placement (P = 0.01), stricture site in D3 (distal part of the papilla) (P = 0.01), and a Glasgow Prognostic Score (GPS) of 0–1 before duodenal stent placement (P < 0.001) were factors significantly associated with prolonged OS. In conclusion, patients with a GPS of 0–1 and D3 stricture who are tolerant of chemotherapy are suitable candidates for DS placement.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction

Takamatsu

Fujimori

Miyagahara

et al. 2022

Sci Rep

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“…However, in our study population, there was no bleeding after stenting, which is another typical early major complication. [ 5 , 6 , 15 ] There were no long-term complications associated with stenting, i.e., there were no cases with stent migration or late perforation. While mortality was significant in both patient populations, there were no procedure-associated deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Less invasive techniques, such as laparoscopic GJ and endoscopic duodenal stenting with self-expanding metal stents (SEMS), have recently increased in popularity. [ 1 – 3 ] While earlier studies have reported lower morbidity associated with endoscopy, long-term functional outcomes are reportedly better after surgery [ 4 , 5 ]. As patients with advanced and incurable cancer are often particularly frail, the advantages of endoscopy have included that endoscopic procedures can be performed in sedation, in contrast to GJ, which requires general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction

Laitamäki

Tyrväinen

Lehto

et al. 2022

Langenbecks Arch Surg

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Background Surgical gastrojejunostomy has traditionally been the palliative treatment of choice for patients with advanced malignancies and gastric outlet obstruction syndrome. Recently, palliative endoscopic duodenal stenting has increased in popularity. We report outcomes after gastrojejunostomy and duodenal stenting when used for palliative indications. Methods Consecutive patients undergoing palliative gastrojejunostomy or palliative endoscopic duodenal stenting in a Finnish tertiary referral center between January 2015 and December 2020 were included. The postoperative outcomes of these two palliative interventions were compared. The main outcome measures were mortality and morbidity, rate of reoperations, postoperative oral intake ability, and length of hospital stay. Results A total of 88 patients, 46 (52%) patients underwent palliative gastrojejunostomy and 42 (48%) duodenal stenting. All patients had malignant disease, most typically hepatopancreatic cancer. Nineteen (44%) patients in duodenal stenting group and 4 (8.7%) patients in gastrojejunostomy group required subsequent interventions due to persisting or progressing symptoms (p < 0.001). Median delay until first oral intake was 2 days (1–24) after gastrojejunostomy and 0 days (0–3) after stenting (p < 0.001). Postoperative morbidity was 30% after gastrojejunostomy and 45% after stenting (p < 0.001). Median length of hospital stay was 7 days (1–27) after surgery and 5 days (0–20) after endoscopy (p < 0.001). Conclusions Patients undergoing endoscopic duodenal stenting are more able to initiate rapid oral intake and have shorter hospital stay. On the other hand, there are significantly more reoperations in stenting group. If the patient’s life expectancy is short, we recommend stenting, but for patients whose life expectancy is longer, gastrojejunostomy could be a better procedure, for the reasons mentioned above.

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“…5 Among the treatments mentioned, metallic stent placement is only one to directly treat the obstruction point; however, patency typically lasts less than a year according to one report, about 9 months. 6 It can be used for only malignant ALO cases with a short life expectancy, On the other hand, it should not be used for benign ALO cases with a long life expectancy. Other treatments are those that do not directly manipulate the obstruction point and can only drain and wait for release.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

Kwon

Lee

2020

Int J Gastrointest Interv

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Benign afferent loop obstruction (ALO) is a complication that occurs after general surgery making Roux-en-Y or Billroth-II reconstruction and has typically been treated surgically. However, the surgery is difficult to conduct in about 25% of cases due to comorbidity and nonoperative management has been attempted. Here, we report two cases of benign ALO that were treated with percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter, including one case with no improvement after surgery.

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Outcomes of duodenal stenting: Experience in a French tertiary center with 220 cases

Cited by 13 publications

References 30 publications

The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction

The Glasgow Prognostic Score and stricture site can predict prognosis after endoscopic duodenal stent placement for malignant gastric outlet obstruction

Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction

Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

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