The efficacy and safety of duodenal stenting: a prospective multicenter study

• Published in: Endoscopy Vol. 39; no. 9; p. 784
• Main Authors: Graber, I, Dumas, R, Filoche, B, Boyer, J, Coumaros, D, Lamouliatte, H, Legoux, J L, Napoléon, B, Ponchon, T
• Format: Journal Article
• Language: English
• Published: Germany 01-09-2007
• Subjects: Adenocarcinoma - complications; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Common Bile Duct Neoplasms - complications; Constriction, Pathologic; Duodenal Obstruction - etiology; Duodenal Obstruction - therapy; Duodenoscopy; Female; Humans; Male; Middle Aged; Neoplasms - complications; Palliative Care; Pancreatic Neoplasms - complications; Prospective Studies; Prosthesis Implantation; Stents; Treatment Outcome
• ISSN: 1438-8812
• DOI: 10.1055/s-2007-966594

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).
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.
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.
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.