Masuda S, Ichita C, Koizumi K. Practical guide to duodenal stenting for gastric outlet obstruction: Clinical outcomes, selection criteria, placement techniques, and management strategies. World J Gastrointest Endosc 2025; 17(6): 107189 [DOI: 10.4253/wjge.v17.i6.107189]
Corresponding Author of This Article
Sakue Masuda, MD, Department of Gastroenterology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kanagawa 247-8533, Japan. sakue.masuda@tokushukai.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jun 16, 2025; 17(6): 107189 Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.107189
Practical guide to duodenal stenting for gastric outlet obstruction: Clinical outcomes, selection criteria, placement techniques, and management strategies
Sakue Masuda, Chikamasa Ichita, Kazuya Koizumi
Sakue Masuda, Chikamasa Ichita, Kazuya Koizumi, Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Author contributions: Masuda S was major contributors to writing the manuscript; Ichita C and Koizumi K designed the outline and coordinated the writing of the manuscript; Ichita C and Koizumi K provided input for writing the paper.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sakue Masuda, MD, Department of Gastroenterology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kanagawa 247-8533, Japan. sakue.masuda@tokushukai.jp
Received: March 18, 2025 Revised: April 18, 2025 Accepted: May 16, 2025 Published online: June 16, 2025 Processing time: 85 Days and 20.1 Hours
Abstract
Duodenal stenting is a widely used palliative treatment for gastric outlet obstruction (GOO) caused by unresectable malignancies. Compared to surgical gastrojejunostomy, duodenal stenting allows for earlier oral intake, shorter hospitalization, and earlier chemotherapy initiation. However, its long-term efficacy is limited by stent occlusion, which typically occurs 2-4 months post-procedure, due to tumor ingrowth, overgrowth, or food impaction. Covered stents can reduce tumor ingrowth but increase the migration risk, particularly in patients receiving chemotherapy. This review provides a comprehensive comparison of duodenal stenting, surgical gastrojejunostomy, and endoscopic ultrasound-guided gastroenterostomy, by discussing their clinical outcomes, advantages, and limitations. We further explore stent selection based on stricture characteristics, optimal placement techniques, post-procedural management, and for handling complications including occlusion, migration, bleeding, and perforation. Additionally, we address technical challenges and troubleshooting strategies, including management of guidewire-induced perforation, incomplete stent expansion, and bile duct obstruction for overlapping biliary and duodenal stricture cases. Despite its widespread clinical use, no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively. By providing a clinically oriented, practical guide, this review serves as a valuable resource for endoscopists and gastroenterologists, facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
Core Tip: Duodenal stenting is a widely used palliative treatment for gastric outlet obstruction (GOO), offering early oral intake and shorter hospitalization compared to surgical bypass. However, long-term outcomes are impacted by stent occlusion, migration, and other complications. This review comprehensively compares duodenal stenting with surgical gastrojejunostomy and endoscopic ultrasound-guided gastroenterostomy, providing insights into optimal stent selection, placement techniques, post-procedural management, and troubleshooting strategies. By addressing key clinical challenges and areas requiring further research, this review serves as a practical guide to optimizing duodenal stenting for GOO in real-world practice.
