S1001 Outcomes of Duodenal Stent Placement for Malignant Gastric Outlet Obstruction. Experience for a Large Tertiary Care Center

Abstract

Introduction: Endoscopic duodenal stent (DS) placement is a recognized treatment for the palliation of malignant gastric outlet obstruction (GOO). While highly effective and safe, the durability of palliation has been in question due to delayed adverse events. This study aimed to evaluate the clinical outcomes of duodenal stent placement in a large academic cancer center. Methods: This is a single-center retrospective study. Data were collected from all patients who underwent DS placement between January 2012 and August 2020. The primary endpoint was clinical success, defined as oral intake 1-week after DS placement (Gastric Outlet Obstruction Scoring System, GOOSS >1). Secondary endpoints were stent occlusion, need for re-interventions, and adverse events. Results: A total of 223 patients were included; 112 (51%) were female and 144 (64%) White. The median age was 63 (IQR 56-70). The etiologies for malignant GOO were: pancreatic cancer 98 (44%), gastric cancer 35 (15.7%), cholangiocarcinoma 21 (9.4%), colorectal cancer 13 (5.8%), and others. The most common site of obstruction was the duodenum, proximal to the major papilla 106 (48%), and the majority of patients were unable to tolerate PO intake (GOOSS=0) 169 (78%) prior to DS placement. After DS placement, 185 (88%) patients were started on a diet within one-week (GOOSS >1), p < .05. Two patients had minor intraprocedural complications, and 114 (51.1%) patients reported delayed adverse events, the most common being stent occlusion due to tissue ingrowth in 52 (23.3%). In this group, the median duration of stent patency was 51 days (IQR 13-196) (Figure 1). Endoscopic revisions were required in 84 (38%) patients, and a new stent was placed in the first revision in 49 patients (22%). Neither etiology nor location of stenosis was found to be a statistically significant predictor of clinical success or stent patency. Median survival after DS placement was 90 days (IQR 38-193). Conclusion: The results of this long-term study of DS placement at a major US academic cancer center demonstrate its continued safety and efficacy for the short-term palliation of malignant GOO. However, stent failure requiring repeat intervention limits the long-term effectiveness of duodenal stents, and therefore alternative approaches should be considered for patients who require long-term palliation of malignant GOO.