Factors Affecting Patency of Uncovered Duodenal Stents in Malignant Duodenal Stenosis Due to Pancreatic Cancer: A Retrospective Cohort Study

Introduction Malignant duodenal stenosis is a common complication in patients with pancreatic cancer, significantly impairing quality of life by obstructing oral intake. Duodenal stenting has become a preferred palliative intervention, offering minimally invasive symptom relief and allowing for the continuation of systemic chemotherapy. However, factors influencing stent patency remain underexplored. This study aimed to identify clinical, procedural, and tumor-related factors that affect the patency of uncovered duodenal stents in malignant duodenal stenosis caused by pancreatic cancer. Methods A retrospective cohort study was conducted at Chiba University Hospital, Chiba, Japan, analyzing data from 53 patients who underwent placement of 22 mm uncovered duodenal stents between June 2016 and December 2023. Eligibility criteria included that the primary tumor had not been resected and that no intestinal reconstruction had been performed. Data on patient demographics, tumor characteristics, procedural details, and outcomes were collected. Univariate and multivariate analyses were performed to evaluate factors influencing stent patency using the Kaplan-Meier method and Cox proportional hazards modeling. Results The mean patency duration for uncovered duodenal stents was 474 days, with stent occlusion occurring in 11 (20.8%) patients. Univariate analysis identified prior placement of transpapillary biliary plastic stents as significantly associated with reduced stent patency (p = 0.0057). Multivariate analysis confirmed this as an independent predictor of shorter patency (hazard ratio, 5.75; 95% CI, 1.37-24.22; p = 0.017). Tumor size, chemotherapy administration, and the location of duodenal stenosis were not significantly associated with stent patency. Conclusions Prior placement of transpapillary biliary plastic stents significantly reduces the patency of uncovered duodenal stents in patients with malignant duodenal stenosis caused by pancreatic cancer. This underscores the importance of procedural planning, including consideration of alternative biliary drainage methods, to optimize stent performance and improve patient outcomes.