title: Palliation of malignant biliary and duodenal obstruction with combined metallic stenting.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance.
  
  
  METHODS
  A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach.
  
  
  RESULTS
  Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively.
  
  
  CONCLUSIONS
  Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.
authors.affiliation: Department of Radiology, Hacettepe University School of Medicine, 06100 Sihhiye, Ankara, Turkey. akincid@hotmail.com
authors.forename: Devrim
authors.initials: D
authors.lastname: Akinci
authors.forename: Okan
authors.initials: O
authors.lastname: Akhan
authors.forename: Fuat
authors.initials: F
authors.lastname: Ozkan
authors.forename: Turkmen
authors.initials: T
authors.lastname: Ciftci
authors.forename: Orhan S
authors.initials: OS
authors.lastname: Ozkan
authors.forename: Musturay
authors.initials: M
authors.lastname: Karcaaltincaba
authors.forename: Mustafa N
authors.initials: MN
authors.lastname: Ozmen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004379:Duodenal Neoplasms / Q000150:complications; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D008670:Metals