Practical guide to duodenal stenting for gastric outlet obstruction: Clinical outcomes, selection criteria, placement techniques, and management strategies.

Abstract

Duodenal stenting is a widely used palliative treatment for gastric outlet obstruction (GOO) caused by unresectable malignancies. Compared to surgical gastrojejunostomy, duodenal stenting allows for earlier oral intake, shorter hospitalization, and earlier chemotherapy initiation. However, its long-term efficacy is limited by stent occlusion, which typically occurs 2-4 months post-procedure, due to tumor ingrowth, overgrowth, or food impaction. Covered stents can reduce tumor ingrowth but increase the migration risk, particularly in patients receiving chemotherapy. This review provides a comprehensive comparison of duodenal stenting, surgical gastrojejunostomy, and endoscopic ultrasound-guided gastroenterostomy, by discussing their clinical outcomes, advantages, and limitations. We further explore stent selection based on stricture characteristics, optimal placement techniques, post-procedural management, and for handling complications including occlusion, migration, bleeding, and perforation. Additionally, we address technical challenges and troubleshooting strategies, including management of guidewire-induced perforation, incomplete stent expansion, and bile duct obstruction for overlapping biliary and duodenal stricture cases. Despite its widespread clinical use, no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively. By providing a clinically oriented, practical guide, this review serves as a valuable resource for endoscopists and gastroenterologists, facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.