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Endoscopy 2013; 45(03): 174-181
DOI: 10.1055/s-0032-1326077
Original article
© Georg Thieme Verlag KG Stuttgart · New York

First data on the Evolution duodenal stent for palliation of malignant gastric outlet obstruction (DUOLUTION study): a prospective multicenter study

M. W. van den Berg
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
S. Haijtink
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
P. Fockens
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
F. P. Vleggaar
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
M. G. W. Dijkgraaf
2   Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
P. D. Siersema
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
J. E. van Hooft
1   Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 14 December 2011

accepted after revision 20 November 2012

Publication Date:
24 January 2013 (online)

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Background and study aims: Enteral stent placement has emerged as a safe and effective palliative treatment option for patients with malignant gastric outlet obstruction (GOO). In an attempt to further optimize this treatment new enteral stents have been designed. This study is the first to describe the results regarding technical success, clinical success, complication rate, and stent dysfunction of the Evolution duodenal stent (Cook Medical, Limerick, Ireland).

Patients and methods: A total of 46 patients with symptomatic malignant GOO were included in this prospective multicenter cohort study. All patients who successfully received an Evolution duodenal stent were followed until death.

Results: The technical and clinical success rates were 89 % (95 % confidence interval [CI] 77 % – 95 %) and 72 % (95 %CI 58 % – 83 %), respectively. The GOO Scoring System score, the Global Health Score, and the EuroQol visual analog scale improved significantly (GOOSS and Global Health Score P < 0.0001; EuroQol P = 0.005) when scores before stenting were compared with scores after stent placement. Median survival was 87 days, and stent patency was observed in 67 % for up to 395 days, accounting for death unrelated to the stent as a competing risk. Stent dysfunction occurred in 14 patients (30 %) (stent ingrowth n = 9; stent migration n = 2; extrinsic compression on the stent n = 2; food impaction n = 1).

Conclusion: These first data on the new Evolution duodenal stent show that it is safe and effective for the palliative treatment of symptomatic malignant GOO.

 

  • References

  • 1 Nevitt AW, Vida F, Kozarek RA et al. Expandable metallic prostheses for malignant obstructions of gastric outlet and proximal small bowel. Gastrointest Endosc 1998; 47: 271-276
    CrossrefPubMedGoogle Scholar
  • 2 Soetikno RM, Lichtenstein DR, Vandervoort J et al. Palliation of malignant gastric outlet obstruction using an endoscopically placed Wallstent. Gastrointest Endosc 1998; 47: 267-270
    CrossrefPubMedGoogle Scholar
  • 3 Venu RP, Pastika BJ, Kini M et al. Self-expandable metal stents for malignant gastric outlet obstruction: a modified technique. Endoscopy 1998; 30: 553-558
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Dormann A, Meisner S, Verin N et al. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36: 543-550
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Jeurnink SM, Steyerberg EW, van Hooft JE et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
    CrossrefPubMedGoogle Scholar
  • 6 Kim CG, Choi IJ, Lee JY et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 2010; 72: 25-32
    CrossrefPubMedGoogle Scholar
  • 7 van Hooft JE, Uitdehaag MJ, Bruno MJ et al. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc 2009; 69: 1059-1066
    CrossrefPubMedGoogle Scholar
  • 8 Lee KM, Choi SJ, Shin SJ et al. Palliative treatment of malignant gastroduodenal obstruction with metallic stent: prospective comparison of covered and uncovered stents. Scand J Gastroenterol 2009; 44: 846-852
    CrossrefPubMedGoogle Scholar
  • 9 Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointest Endosc 2007; 66: 355-360
    CrossrefPubMedGoogle Scholar
  • 10 Havemann MC, Adamsen S, Wojdemann M. Malignant gastric outlet obstruction managed by endoscopic stenting: a prospective single-centre study. Scand J Gastroenterol 2009; 44: 248-251
    CrossrefPubMedGoogle Scholar
  • 11 Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002; 97: 72-78
    CrossrefPubMedGoogle Scholar
  • 12 van Hooft JE, Vleggaar FP, Le MO et al. Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 2010; 72: 530-535
    CrossrefPubMedGoogle Scholar
  • 13 Aaronson NK, Ahmedzai S, Bergman B et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
    CrossrefPubMedGoogle Scholar
  • 14 Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33: 337-343
    CrossrefPubMedGoogle Scholar
  • 15 Ludbrook J, Royse AG. Analysing clinical studies: principles, practice and pitfalls of Kaplan-Meier plots. ANZ J Surg 2008; 78: 204-210
    CrossrefPubMedGoogle Scholar
  • 16 Ly J, O’Grady G, Mittal A et al. A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc 2010; 24: 290-297
    CrossrefPubMedGoogle Scholar
  • 17 Hosono S, Ohtani H, Arimoto Y et al. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 2007; 42: 283-290
    CrossrefPubMedGoogle Scholar
  • 18 Shi D, Liao SH, Geng JP. A newly designed big cup nitinol stent for gastric outlet obstruction. World J Gastroenterol 2010; 16: 4206-4209
    CrossrefPubMedGoogle Scholar
  • 19 Song HY, Shin JH, Yoon CJ et al. A dual expandable nitinol stent: experience in 102 patients with malignant gastroduodenal strictures. J Vasc Interv Radiol 2004; 15: 1443-1449
    CrossrefPubMedGoogle Scholar
  • 20 Kim YW, Choi CW, Kang DH et al. A double-layered (comvi) self-expandable metal stent for malignant gastroduodenal obstruction: a prospective multicenter study. Dig Dis Sci 2011; 56: 2030-2036
    CrossrefPubMedGoogle Scholar
  • 21 van Hooft JE, van Montfoort ML, Jeurnink SM et al. Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy 2011; 43: 671-675
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Kim JH, Song HY, Shin JH et al. Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 2007; 66: 256-264
    CrossrefPubMedGoogle Scholar
  • 23 Shaw JM, Bornman PC, Krige JE et al. Self-expanding metal stents as an alternative to surgical bypass for malignant gastric outlet obstruction. Br J Surg 2010; 97: 872-876
    CrossrefPubMedGoogle Scholar
  • 24 Baron TH, Harewood GC. Enteral self-expandable stents. Gastrointest Endosc 2003; 58: 421-433
    CrossrefPubMedGoogle Scholar
  • 25 Bessoud B, de Baere T, Denys A et al. Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 2005; 16: 247-253
    CrossrefPubMedGoogle Scholar
  • 26 Phillips MS, Gosain S, Bonatti H et al. Enteral stents for malignancy: a report of 46 consecutive cases over 10 years, with critical review of complications. J Gastrointest Surg 2008; 12: 2045-2050
    CrossrefPubMedGoogle Scholar
  • 27 Kim SY, Song HY, Kim JH et al. Bridging across the ampulla of Vater with covered self-expanding metallic stents: is it contraindicated when treating malignant gastroduodenal obstruction?. J Vasc Interv Radiol 2008; 19: 1607-1613
    CrossrefPubMedGoogle Scholar
  • 28 Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001; 344: 1681-1687
    CrossrefPubMedGoogle Scholar