This case series aimed to better elucidate the short and long-term outcomes of palliative stenting in the distal duodenum. Both intestinal bleeding and stent migration were observed with an overall adverse event rate of 11.7%. Both intestinal bleeding and stent migration occurred at rates of 5.9%. These rates are comparable to previous studies that looked at gastric and proximal duodenal stenting, which found overall adverse event rates and migration rates of 17% and 11%, respectively . This survey represents one of the first to look at duodenal stenting specifically in the D3 and D4 portions, as previous studies have not differentiated between where stents were placed in the duodenum .
Tumor ingrowth has been noted as one of the most common causes of symptom recurrence . 3 out of 17 (17.6%) patients reviewed experienced symptom recurrence with endoscopy-confirmed tumor ingrowth. In all cases, repeat endoscopic stenting resulted in symptomatic improvement with no additional observed adverse events. The rate of tumor ingrowth in this study was comparable to stents placed in more proximal regions of the duodenum, which recorded occlusion rates of approximately 23% .
Previous clinical trials have shown SEMS placed in the antral region of the stomach and D1 and D2 portions of the duodenum to be highly effective in improving symptomatic GOO, estimated at rates greater than 85% [1, 6]. With 16 out of 17 patients experiencing symptomatic relief, SEMS placement in the D3 and D4 portion of the duodenum reproduced clinical efficacy rates in line with previously studied locations for SEMS deployment.
This survey confirms that palliative duodenal stenting is an effective and safe treatment for patients with symptomatic duodenal obstruction despite possible study limitations with over 90 percent of patients experiencing relief following SEMS placement. These limitations include restricted sample size as well as access to follow-up health records. It is possible that additional adverse events occurred in patients that received care at other facilities, and therefore were not accessible to our group. Additional follow-up is warranted to confirm the findings of this survey and better elucidate the possible technical limitations of placing SEMS in the distal duodenum.
In conclusion, our survey found that SEMS placed in the D3 and D4 portion of the duodenum have adverse event rates comparable to SEMS placed in the D1 and D2 portions of the duodenum. This offers additional therapy options for patients with symptomatic obstruction localized to the distal duodenum and are appropriate candidates for endoscopic intervention.