Outcomes of patients with malignant duodenal obstruction after receiving self-expandable metallic stents: A single center experience

Wei, Tien-Hsin; Ye, Bing-Wei; Wu, Po Kuei; Li, Chung–Pin; Chao, Yee; Lee, Pei‐Chang; Huang, Yi‐Hsiang; Lee, Kuei–Chuan; Hou, Ming‐Chih

doi:10.1371/journal.pone.0268920

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…Patency was similar to the previous reports. 11,12,18 The patency can be exaggerated due to short survival time (median 90 days). However, as median patency is longer than the median survival, secondary stenting would be a good option for obstructed duodenal stent.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study

So,

Joo,

Song

et al. 2024

Gut and Liver

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Background/Aims: Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction. Methods:We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events.Results: A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%). Conclusions:Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study

So,

Joo,

Song

et al. 2024

Gut and Liver

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“…[20][21][22][23] Previous retrospective studies investigating poststent chemotherapy after GDS placement reported improved survival outcomes. 7,[9][10][11][12][13][14][15] However, none of these reports performed a time-dependent analysis, which might have accentuated the impact of chemotherapy on survival due to an immortal time bias. Timedependent exposures, such as post-stent chemotherapy, have been suggested to be included as time-dependent variables in hazardbased analyses to minimize the risk of immortal bias in observational studies of survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In all of these reports, chemotherapy after GDS placement reportedly improved the prognosis of MGOO patients. 7,[9][10][11][12][13][14][15] However, no study has yet analyzed the effect of chemotherapy as a time-dependent covariate on survival after GDS placement. Furthermore, there are no reports on the prognostic impact of clinical disease course following GDS placement, such as stent dysfunction or complications of cholangitis associated with bile duct obstruction.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of clinical outcome after endoscopic gastroduodenal stent placement for malignant gastric outlet obstruction: a multicenter retrospective cohort study using a time-dependent analysis

Hodo

Takatori

Komura

et al. 2023

Therap Adv Gastroenterol

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Background: Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias. Objectives: To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis. Design: Multicenter retrospective cohort study. Methods: This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates. Results: Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement ( p < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68–103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0–1 [hazard ratio (HR): 0.55, 95% CI: 0.40–0.75; p < 0.001], ascites (HR: 1.45, 95% CI: 1.04–2.01; p = 0.028), metastasis (HR: 1.84, 95% CI: 1.31–2.58; p < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37–4.15; p = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002–0.10; p < 0.001) significantly affected prognosis after GDS placement. Conclusion: Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.

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“…The recent developments in intensive chemotherapy are expected to prolong survival in patients with gastric and pancreatic cancers and associated GOO. Chemotherapy after stent placement is helpful in extending the survival period in all carcinomas ( 40 , 41 , 48 , 49 ), pancreatic cancers ( 50 , 51 ) and non-pancreatic cancers ( 51 ).…”

Section: Considerations For Endoscopic Stentingmentioning

confidence: 99%

“…The results of previous studies regarding the predictors of survival in patients with malignant GOO are shown in Table 6 . Various predictors have been reported ( 40 , 41 , 48 , 49 , 57 – 59 ). Further studies are warranted to establish suitable predictors of survival time.…”

Section: Considerations For Endoscopic Stentingmentioning

confidence: 99%

How to successfully administer palliative treatment with a stent for malignant gastric outlet obstruction?

Maetani

2022

Front. Med.

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Although endoscopic stenting (ES) has been widely used as a less-invasive palliation method for malignant gastric outlet obstruction (GOO), recent reports have highlighted issues related to the procedure. For successful treatment, various aspects must be assessed before considering the practices. First, it is necessary to eliminate cases with contraindications such as coexistence of distal small-bowel obstruction or perforation. Other factors potentially related to clinical failure (i.e., peritoneal carcinomatosis) may require consideration but remain controversial. ES has better short-term outcomes than surgical gastrojejunostomy (GJ). GJ has recently been considered preferable in cases with longer life expectancy because of superior sustainability. Various types of stents are now commercially available, but their ideal structure and mechanical properties have not yet been clarified. Covered metal stent may reduce stent obstruction but is prone to increase stent migration, and its significance remains uncertain. Subsequent chemotherapy after stenting should be considered, as it is expected to prolong patient survival without increasing the risk of adverse events. Furthermore, it may be helpful in preventing tumor ingrowth. In cases with GOO combined with biliary obstruction, biliary intervention is often difficult. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used as an alternative procedure for endoscopic transpapillary biliary drainage (ETBD). Despite the lack of consensus as to whether ETBD or EUS-BD is preferred, EUS-BD is useful as a salvage technique for cases where ETBD is difficult. To perform stent placement successfully, it is important to pay attention to the above points; however, many remaining issues need to be clarified in the future.

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Outcomes of patients with malignant duodenal obstruction after receiving self-expandable metallic stents: A single center experience

Cited by 7 publications

References 34 publications

Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study

Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study

Prognostic impact of clinical outcome after endoscopic gastroduodenal stent placement for malignant gastric outlet obstruction: a multicenter retrospective cohort study using a time-dependent analysis

How to successfully administer palliative treatment with a stent for malignant gastric outlet obstruction?

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