Self-expandable duodenal metal stent placement for the palliation of gastric outlet obstruction over the past 20 years.

Autor:	Reijm AN; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Zellenrath PA; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., van der Bogt RD; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., van Driel LMJW; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Siersema PD; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands., Bruno MJ; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2022 Dec; Vol. 54 (12), pp. 1139-1146. Date of Electronic Publication: 2022 Apr 28.
DOI:	10.1055/a-1838-5642
Abstrakt:	Introduction: Duodenal stent placement is a palliative option for management of malignant gastric outlet obstruction (GOO). In the last 20 years, management of gastrointestinal cancers has considerably changed. It is unknown if these changes have affected clinical outcome of duodenal stent placement. Methods: Retrospective cohort study conducted in a tertiary referral center. Patients who underwent duodenal stent placement for GOO-symptoms due to a malignant stricture were included. Primary outcome was GOO-symptom free survival. Secondary outcomes included stent-related adverse event rates. Potential explanatory parameters such as period of stent placement (1998-2009 vs 2010-2019), prior treatments, peritoneal deposits, and stricture length were evaluated using multivariable Cox regression analysis. Results: A total of 147 patients (62 % male; median age 64 years) were included. After a median of 28 days after stent placement, 82 patients (57 %) had recurrent GOO-symptoms. GOO-symptom free survival was significantly lower in 2010-2019 (P < 0.01). Time period was the only independent predictor for reduced GOO-symptom free survival (HR 1.76, P < 0.01). Stent-related adverse event rates increased over time (1998-2009: 31 % vs 2010-2019: 37 %). Prior treatment with chemotherapy and/or radiotherapy was significantly associated with an increased risk of adverse events (OR 2.53, P = 0.02). Conclusions: Clinical outcome of duodenal stent placement did not improve over time. The decreased GOO-symptom free survival and increased adverse event rate in more recent years are probably related to the chemo- and/or radiotherapy treatment provided prior to duodenal stent placement. Competing Interests: M. C. W. Spaander has received research support from Medtronic, Norgine, and Boston Scientific. P. D. Siersema has recieved research support from Pentax, The E-Nose company, Lucid Diagnostics, MicroTech, Motus GI, Magentiq Eye and Endo Tools Therapeutics. M. J. Bruno has recieved research support from Boston Scientific, Cook Medical, Pentax Medical, Mylan, Interscope and ChiRoStim. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)
Databáze:	MEDLINE
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