title: Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan.
abstract: OBJECTIVE
  Endoscopic gastroduodenal stenting for malignant gastric outlet obstruction recently has become more effective, but the factors that predict gastroduodenal stenting outcomes are poorly defined. This multicenter retrospective cohort study evaluated the clinical outcomes of gastroduodenal stenting in malignant gastroduodenal obstruction and identified factors predicting clinical ineffectiveness, stent dysfunction, and adverse events.
  
  
  METHODS
  All consecutive patients with malignant gastroduodenal obstruction who underwent through-the-scope gastroduodenal stenting from 2009 to 2014 at 4 tertiary-care medical centers were identified. Clinically ineffective stenting was defined as symptom recurrence and a gastric outlet obstruction scoring system (GOOSS) score <2.
  
  
  RESULTS
  Of the 278 patients (mean age ± standard deviation [SD] 71.7 ± 11.4 years), 121 (43.5%) and 87 (31.3%) had pancreatic and gastric cancer, respectively. Technical success was achieved in 277 patients (99.6%). GOOSS scores rose from 0.5 ± 0.6 to 2.6 ± 0.8. Stenting was ineffective in 32 patients (12.6%). Stent dysfunction that caused symptom recurrence during follow-up developed in 46 patients (16.6%). Adverse events occurred in 49 patients (17.7%). Three or more stenosis sites (odds ratio [OR] = 6.11; P < .01) and Karnofsky performance scores ≤50 (OR = 6.63; P < .01) predicted clinical ineffectiveness. Karnofsky performance scores ≤50 predicted stent dysfunction (hazard ratio [HR] = 3.63; P < .01). Bile duct stenosis (HR = 9.55; P = .02) and liver metastasis (HR = 9.42; P < .01) predicted stent overgrowth. Covered stent predicted stent migration (HR = 12.63; P < .01). Deployment of 2 stents predicted perforation (HR = 854.88; P < .01).
  
  
  CONCLUSIONS
  Through-the-scope gastroduodenal stenting tended to be ineffective in patients with poor performance status and long stenosis sites. Stent dysfunction occurred more frequently in patients with poorer performance status. Deployment of 2 stents was a risk factor for perforation. Identification of these risk variables may help yield better gastroduodenal stenting outcomes.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kayahara
authors.affiliation: Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Etsuji
authors.initials: E
authors.lastname: Ishida
authors.affiliation: Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Minaga
authors.affiliation: Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Asada
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Okabe
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
authors.affiliation: Clinical Research Center, Kinki University Hospital, Osaka-sayama, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Chiba
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-sayama, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000150:complications; D004067:Digestive System Neoplasms / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007564:Japan; D017567:Karnofsky Performance Status; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D017211:Treatment Failure