title: Duodenal stenting followed by systemic chemotherapy for patients with pancreatic cancer and gastric outlet obstruction.
abstract: OBJECTIVE
  Endoscopic duodenal stenting has recently been proposed as a substitute for surgical gastrojejunostomy for the treatment of gastric outlet obstruction. We aimed to evaluate the efficacy and safety of duodenal stenting followed by systemic chemotherapy for patients with advanced pancreatic cancer with gastric outlet obstruction.
  
  
  METHODS
  This was a single-center, retrospective cohort study, conducted at an academic medical center, of 71 patients with advanced pancreatic cancer and gastric outlet obstruction (mean age: 67.6 years; range: 31-92 years) who underwent duodenal stenting with or without subsequent chemotherapy. Overall survival, duration of oral intake of foods, the rate of introduction of chemotherapy, progression-free survival, and adverse events were evaluated.
  
  
  RESULTS
  Stent placement was technically successful in 69 (97%) patients. Thirty-six (51%) patients were treated with chemotherapy: 17 with gemcitabine alone, 15 with S-1 alone, 3 with FOLFIRINOX, and 1 with paclitaxel. Median progression-free survival and overall survival after chemotherapy were 2.6 months (95% confidence interval: 1.3-3.9 months) and 4.7 months (95% confidence interval: 2.6-6.8 months), respectively. Cases of grade 3 anemia were frequently observed during chemotherapies following duodenal stenting (32%). Tumor stage, performance status, neutrophil-to-lymphocyte ratio, and introduction of chemotherapy were independent prognostic factors for survival (hazard ratios of 3.73, 2.21, 2.69, and 1.85 with p-values of <0.001, 0.010, <0.001, and 0.045, respectively).
  
  
  CONCLUSIONS
  The findings of this study suggest that endoscopic duodenal stenting is an advantageous treatment in advanced pancreatic cancer patients with gastric outlet obstruction regarding its safety and smooth conduction of subsequent chemotherapies.
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan. Electronic address: kobayashis@kcch.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kameda
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Moriya
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Irie
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Goda
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Tezuka
authors.affiliation: Department of Gastroenterology, Yamato Municipal Hospital, Yamato, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yanagida
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohkawa
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Morinaga
authors.affiliation: Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004358:Drug Therapy / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D004435:Eating; D005260:Female; D017219:Gastric Outlet Obstruction / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Drug therapy; Palliative care; Safety; Stents; Survival