Clinical outcomes and predictive factors for stent patency in malignant duodenojejunal obstruction: comparison of distal duodenum and proximal jejunum.

BACKGROUND

Endoscopic self-expandable metal stents (SEMSs) provide a minimally invasive treatment for malignant duodenal obstructions. However, data on stenting of the distal duodenum and proximal jejunum are limited. Therefore, this study aimed to evaluate stent patency and survival outcomes in patients who underwent SEMS placement for distal duodenal (DD) and proximal jejunal (PJ) obstructions.

METHODS

This retrospective cohort study included 73 patients who underwent SEMS placement for malignant duodenojejunal obstruction. The clinical success and procedural outcomes were analyzed. Stent patency and overall survival were analyzed using survival analyses, including Cox proportional hazards modeling.

RESULTS

The technical and clinical success rates were 98.6% and 86.3%, respectively. The median stent patency time was 276.0 days (95% CI, 226.0-482.0), and the median overall survival after stenting was 127.0 days (95% CI, 69.0-201.0). Poststenting chemotherapy was significantly associated with prolonged stent patency (hazard ratio, 0.16; P =.005), whereas stent type was not a significant predictor. Stent dysfunction occurred in 42.5% of patients, primarily due to tumor ingrowth (34.2%).

CONCLUSION

Endoscopic DD and PJ stenting for malignant obstructions demonstrated high technical success and clinical efficacy. Poststenting chemotherapy was associated with prolonged stent patency. Despite a relatively high dysfunction rate, endoscopic SEMSs may be an effective palliative option.