Efficacy and Safety of Duodenal Stenting for Malignant Gastric Outlet Obstruction: Insights From a 15-year Single-Center Experience

Abstract

Objectives

Endoscopic duodenal stent (DS) placement has become a primary palliative approach for malignant gastric outlet obstruction (MGOO), offering minimally invasive symptom relief. However, complications and risk factors for stent dysfunction and prognostic indicators of survival are not fully elucidated.

Methods

We retrospectively analyzed 114 patients who underwent initial DS placement for MGOO at Kyushu University Hospital between January 2010 and October 2024. Clinical outcomes, stent patency, and survival predictors were analyzed. The primary endpoint was stent patency; overall survival (OS) was a secondary endpoint.

Results

Pancreatic cancer was the most common underlying malignancy (77.2%). Technical and clinical success rates were 99.1% and 84.1%, respectively; the overall clinical success rate reached 91.2% after additional stenting in initially unsuccessful cases. Adverse events occurred in 12.3% of patients. Among 104 patients with overall clinical success, 18 patients (17.3%) experienced stent dysfunction. Median stent patency and OS were 14.8 and 2.8 months, respectively. Pre-existing biliary stricture and stent placement across the pylorus were significantly associated with reduced stent patency. High neutrophil-to-lymphocyte ratio predicted poorer survival, whereas type III stenosis and post-stenting chemotherapy were linked to improved survival. No significant differences in outcomes were observed between early and late treatment periods. Reintervention with DS was safe and effective, and 93.3% of patients maintained GOO control with DS alone.

Conclusions

Duodenal stenting is a safe and effective palliative intervention for MGOO. Incorporating inflammation-based biomarkers and individualized treatment strategies can help optimize patient selection and improve survival outcomes.