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

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Gut and Liver Pub Date : 2024-05-22 DOI:10.5009/gnl240014

Hoonsub So, Hyun Don Joo, Tae Jun Song, Sung Woo Ko, Ho Seung Lee, Sung Hyun Cho, Dongwook Oh, Sung Yong Han, Dong Uk Kim, Dong-Wan Seo

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Abstract

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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恶性十二指肠梗阻患者二次十二指肠自扩张金属支架治疗十二指肠支架功能障碍的临床疗效：一项回顾性多中心研究。

背景/目的：内镜超声引导下胃空肠吻合术（EUS-GJ）的疗效与外科胃空肠吻合术或十二指肠支架术相当。然而，EUS-GJ 在技术上具有挑战性。十二指肠自膨式金属支架（SEMS）置入术很受欢迎，但阻塞也很常见。十二指肠 SEMS 梗阻可通过以支架中支架的方式插入第二个 SEMS 来处理。因此，我们旨在分析恶性十二指肠梗阻患者二次十二指肠SEMS置入术的临床效果：我们回顾性分析了2016年1月至2021年12月期间因十二指肠支架功能障碍而接受二次十二指肠支架植入术的患者数据。主要结果是支架通畅。次要结果为临床成功率、功能障碍相关因素、患者存活率和不良事件：结果：共纳入 109 例患者。平均年龄为（64.4±11.2）岁，63 名患者（57.8%）为男性。92例患者（84.4%）患有胰胆管癌。94例（86.2%）获得了临床成功。23名患者出现支架功能障碍，中位支架通畅时间为231天（95%置信区间[CI]，169天至不详）。在对支架通畅率进行多变量 Cox 危险分析后，东部合作肿瘤学组表现状态（危险比 [HR]，2.13；95% CI，1.20 至 3.81；P=0.010）和首次支架通畅时间≥6 个月（HR，0.33；95% CI，0.11 至 0.95；P=0.050）仍是重要的相关因素。5名患者（4.6%）发生了不良事件：结论：二次十二指肠支架植入是首次十二指肠支架阻塞的可行方案。结论：二次十二指肠支架植入术是治疗首次十二指肠支架阻塞的可行方案，有必要对手术或 EUS-GJ 治疗十二指肠支架阻塞进行进一步的比较研究。

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来源期刊

Gut and Liver 医学-胃肠肝病学

CiteScore

7.50

自引率

8.80%

发文量

119

审稿时长

6-12 weeks

期刊介绍： Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.