© Georg Thieme Verlag KG Stuttgart · New York
The efficacy and safety of duodenal stenting: a prospective multicenter study
submitted 19 December 2006
accepted after revision 30 April 2007
17 August 2007 (online)
Background and study aims: Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Société Française d’Endoscopie Digestive (SFED).
Patients and methods: A total of 51 patients were selected (mean age 72), the majority (69 %) having pancreatic adenocarcinoma. Palliative treatment was chosen because of irresectability (61.2 %), inoperability (18.4 %), or both (20.4 %). Enteral Wallstent prostheses were used, and the patients were followed up on day 3, after 1 month, and then every month, with weight measurement, and symptomatic and laboratory evaluation.
Results: One prosthesis was sufficient in 46 patients. Stent positioning and deployment were correct in 50/51 patients (98 %). Twenty patients also underwent biliary stenting in addition to the duodenal stenting. On day 3, 43 patients (84 %) were able to tolerate soft solids or a full diet. Six complications were attributed to stenting: three intestinal hemorrhages, two cases of peritonitis due to bowel perforation, and one case of septicemia, and these led to five deaths (mortality 9.8 %). Stent dysfunction was observed in 12 cases (23.5 %) after a mean delay of 75 days, comprising 11-malignant obstructions and one migration: a new stent was inserted inside the first one and was effective in eight cases; and no treatment was given in the other four patients because of their clinical state. The median survival was 71.5 days.
Conclusions: Palliative endoscopic treatment of malignant duodenal stenosis using metallic prostheses is highly feasible, even with associated biliary stenting. Symptomatic improvement is fast. However, the mortality and the obstruction rate are high, suggesting that a prospective trial comparing this treatment with surgery is still required.
- 1 Lillemoe K D, Pitt H A. Palliation: surgical and otherwise. Cancer. 1996; 78 (3 Suppl) 605-614
- 2 Sarr M G, Cameron J L. Surgical palliation of unresectable carcinoma of the pancreas. World J Surg. 1984; 8 906-918
- 3 Watanapa P, Williamson R C. Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg. 1992; 79 8-20
- 4 Weaver D W, Wiencek R G, Bouwman D L, Walt A J. Gastrojejunostomy: is it helpful for patients with pancreatic cancer?. Surgery. 1987; 102 608-613
- 5 Doberneck R C, Berndt G A. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg. 1987; 122 827-829
- 6 Maetani I, Tada T, Ukita T. et al . Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy. 2004; 36 73-78
- 7 Dumas R, Demarquay J F, Caroli-Bosc F X. et al . Palliative endoscopic treatment of malignant duodenal stenosis by metal prosthesis. Gastroenterol Clin Biol. 2000; 24 714-718
- 8 Mittal A, Windsor J, Woodfield J. et al . Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg. 2004; 91 205-209
- 9 Maetani I, Ogawa S, Hoshi H. et al . Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenosis. Endoscopy. 1994; 26 701-704
- 10 Adler D G, Baron T H. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002; 97 72-78
- 11 Maire F, Hammel P, Ponsot P. et al . Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006; 101 735-742
- 12 Tang T, Allison M, Dunkley I. et al . Enteral stenting in 21 patients with malignant gastroduodenal obstruction. J R Soc Med. 2003; 96 494-496
- 13 Lindsay J O, Andreyev H JN, Vlavianos P, Westaby D. Self-expanding metal stents for the palliation of malignant gastroduodenal obstruction in patients unsuitable for surgical bypass. Aliment Pharmacol Ther. 2004; 19 901-905
- 14 Vanbiervliet G, Demarquay J F, Dumas R. et al . Endoscopic insertion of biliary stents in 18 patients with metallic duodenal stents who developed secondary malignant obstructive jaundice. Gastroenterol Clin Biol. 2004; 28 1209-1213
I. Graber, MD
Pavillon H, Hôpital Edouard Herriot