Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study
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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.
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.
참고문헌 (33)
- Maire F, "Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresect able adenocarcinoma of the head of pancreas", Am J Gastroenterol, 101, pp.735~742 (2006)
- Maetani I, "Treating bilio-duodenal ob struction : combining new endoscopic technique with 6 Fr stent introducer", World J Gastroenterol, 16, pp.2828~2831 (2010)
- Andtbacka RH, "Surgical and endoscopic pal liation for pancreatic cancer", Minerva Chir, 59, pp.123~136 (2004)
- "NCCN clinical plactice guidelines in oncology; pancreatic adenocarcinoma, ver sion 1" (2023)[URL]
- D'Souza PM, "Refractory bleeding from a malignant duodenal ulcer treated with placement of a fully-covered gastroduodenal stent", Dig Dis Sci, 58, pp.3359~3361 (2013)
- Orii T, "Efficacy of self-expandable me tallic stent inserted for refractory hemorrhage of duodenal cancer", Case Rep Gastroenterol, 10, pp.151~156 (2016)
- Daiku K, "A case of refractory tumor bleeding from an ampullary adenocarcinoma : compression hemo stasis with a self-expandable metallic stent", DEN Open, 2, pp.e23~ (2022)
- Subramaniam S, "A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection : a randomized controlled trial", Endoscopy, 53, pp.27~35 (2021)
- Mutignani M, "Combined endoscopic stent insertion in malignant biliary and duodenal obstruction", Endoscopy, 39, pp.440~447 (2007)
- Tonozuka R, "Endoscopic double stenting for the treatment of malignant biliary and duodenal obstruction due to pancreatic cancer", Dig Endosc, 25(Suppl 2), pp.100~108 (2013)
- Maetani I, "Palliation in patients with ma lignant gastric outlet obstruction with a newly designed enteral stent : a multicenter study", Gastrointest Endosc, 66, pp.355~360 (2007)
- Maetani I, "Comparison of ultraflex and niti-s stents for palliation of unresectable malignant gastroduodenal obstruction", Dig Endosc, 22, pp.83~89 (2010)
- Adler DG, "Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents : experience in 36 patients", Am J Gastroenterol, 97, pp.72~78 (2002)
- "Common toxicity criteria, version 2.0" (1999)[URL]
- Itoi T, "Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphinc terotomy bleeding", Endoscopy, 43, pp.369~372 (2011)
- Lim SG, "Conformable covered versus uncov ered self-expandable metallic stents for palliation of malignant gas troduodenal obstruction : a randomized prospective study", Dig Liver Dis, 46, pp.603~608 (2014)
- Maetani I, "Placement of a triple-lay ered covered versus uncovered metallic stent for palliation of malig nant gastric outlet obstruction : a multicenter randomized trial", Dig Endosc, 26, pp.192~199 (2014)
- Waidmann O, "SEMS vs cSEMS in duodenal and small bowel obstruction : high risk of migration in the covered stent group", World J Gastroenterol, 19, pp.6199~6206 (2013)
- Takahara N, "A novel partially covered self-expandable metallic stent with proximal flare in patients with malignant gastric outlet obstruction", Gut Liver, 11, pp.481~488 (2017)
- Yamao K, "Endoscopic placement of cov ered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction", Gut, 70, pp.1244~1252 (2021)
- Kim CG, "Covered versus uncovered self-ex pandable metallic stents for palliation of malignant pyloric obstruc tion in gastric cancer patients : a randomized, prospective study", Gastrointest Endosc, 72, pp.25~32 (2010)
- Oh D, "Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction : a pilot study", Gastrointest Endosc, 82, pp.32~36 (2015)
- Woo SM, "Comparison of uncovered and covered stents for the treatment of malignant duodenal obstruction caused by pancreaticobiliary cancer", Surg Endosc, 27, pp.20312039~ (2013)
- Kim JW, "Comparison between uncovered and covered self-expandable metal stent placement in malignant du odenal obstruction", World J Gastroenterol, 21, pp.1580~1587 (2015)
- Kaw M, "Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction", Surg Endosc, 17, pp.457~461 (2003)
- Kim KO, "Effectiveness of combined biliary and duodenal stenting in patients with malignant biliary and duodenal obstruction", Scand J Gastroenterol, 47, pp.962~967 (2012)
- Maetani I, "Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenoses", Endoscopy, 26, pp.701~704 (1994)
- Profili S, "Combined biliary and duodenal stenting for palliation of pancreatic cancer", Scand J Gastroenterol, 38, pp.1099~1102 (2003)
- Moon JH, "Combined endoscopic stent-in stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent(with videos)", Gastrointest Endosc, 70, pp.772~777 (2009)
- Kim ET, "Acute pancreatitis after percutane ous insertion of metallic biliary stents in patients with unresectable pancreatic cancer", Clin Radiol, 75, pp.57~63 (2020)
- Sugawara S, "Frequency, severity, and risk fac tors for acute pancreatitis after percutaneous transhepatic biliary stent placement across the papilla of vater", Cardiovasc Intervent Ra diol, 40, pp.1904~1910 (2017)
- Yang Y, "Incidence and risk factors of pancreati tis in obstructive jaundice patients after percutaneous placement of self-expandable metallic stents", Hepatobiliary Pancreat Dis Int, 19, pp.473~477 (2020)
- Zu QQ, "Percutaneous transpapillary biliary stent placement for distal malignant biliary obstruction : outcomes and survival analysis", Turk J Gastroenterol, 30, pp.714~721 (2019)