Clin Endosc.  2024 Sep;57(5):628-636. 10.5946/ce.2023.155.

Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study

• Sakamoto Y
• Sakamoto T
• Ohba A
• Sasaki M
• Kondo S
• Morizane C
• Ueno H
• Saito Y
• Arai Y
• Okusaka T

• KMID: 2559214
• DOI: http://doi.org/10.5946/ce.2023.155

Abstract

Background/Aims
Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a gastric outlet obstruction scoring system score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

Keyword

Duodenal obstruction; Gastrointestinal hemorrhage; Hemostasis; Pancreatic neoplasms; Self-expandable metallic stent

Figure

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  Fig. 1. Number and details of duodenal stent placement cases from January 2014 to December 2016. The bold boxes indicate the cases included in the study. cSEMS, covered self-expandable metal stent; ucSEMS, uncovered self-expandable metal stent.

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  Fig. 2. Types of duodenal stenosis due to tumor. Type I: Stenosis occurring at the level of the duodenal bulb or upper duodenal genu, but without papillary involvement (see light blue marker area). Type II: Stenosis affecting the second part of the duodenum and involving the papilla (pink marker). Type III: Stenosis affecting the third part of the duodenum distal to the papilla, without involvement of the papilla (yellow marker area).

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  Fig. 3. Nitinol-covered self-expandable metal stent (Niti-S Combi gastroduodenal stent; Taewoong Medical).

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  Fig. 4. Schematic outline of stent placement in a side-by-side position. We positioned the biliary and duodenal stents next to each other to avoid any interference.

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  Fig. 5. Patient 1: Simultaneous placement of biliary and duodenal stents. (A) X-ray showing the simultaneous placement of biliary and duodenal stents. (B) Endoscopic image showing stenosis and bleeding in the duodenum immediately after the stent placement.

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