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Boston Presents Endoscopic Duodenal Stenting Study Results

Boston Scientific has presented results from a study demonstrating that endoscopic duodenal stenting is associated with lower costs and shorter hospital stays than surgical gastrojejunostomy (GJ) for the relief of malignant gastric outlet obstruction. Results of the study were presented at Digestive Disease Week (DDW) by Shyam Varadarajulu.

Boston said that the endoscopic stenting is increasingly performed for the relief of malignant gastric outlet obstruction. An analysis of the Medicare database was conducted to identify hospitalizations for endoscopic stenting and surgical GJ for malignant gastric outlet obstruction between 2006 and 2008.

The database included 423 endoscopic stenting and 352 surgical GJ hospitalizations that met the study inclusion criteria. Results showed that the median cost per hospitalization and the median length of hospital stay (LOS) were less for endoscopic stenting than surgical GJ.

Boston said that the study also evaluated clinical outcomes for 29 patients who underwent endoscopic stenting and 75 patients who underwent surgical GJ at the University of Alabama at Birmingham Hospital, and compared rates of technical and treatment success, post-procedure LOS and delayed complications.

While both treatment methods were technically successful and relieved malignant gastric outlet obstruction, the median post-procedure LOS was significantly shorter for endoscopic stenting than surgical GJ (1.5 vs. 10.7 days, p<0.0001). There was no difference in rates of delayed complications.

Boston Scientific’s WallFlex Duodenal Stent was used in many of the stenting patients in the study. It is a large diameter, radiopaque, flexible, self-expanding metal stent designed to help maintain luminal patency in patients with gastroduodenal obstructions. The stent has looped ends and incorporates a flared design intended to reduce the risk of migration. The low profile, reconstrainable delivery system features a tapered tip to support access and radiopaque markers to aid in placement accuracy.

Varadarajulu, associate professor of medicine, division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, said: “While the technical and clinical outcomes may be similar with the two methods of managing malignant gastric outlet obstruction, these results clearly demonstrate there are significant implications for patient care and resource utilization. In addition, it is important that endoscopic stenting extend beyond teaching hospitals located in urban areas.”

Michael Phalen, senior vice president and president of endoscopy division at Boston Scientific, said: “Palliation of symptoms is the primary treatment goal for patients suffering from malignant gastric outlet obstruction, and this study shows that stenting provides a less-invasive treatment option that is as effective as surgery but offers lower hospital costs and shorter hospital stays. The WallFlex Duodenal Stent reflects this commitment by providing advanced features that enhance stent deliverability, deployment and luminal patency.”