Combined endoscopic stent-in-stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent (with videos).
BACKGROUND
Self-expandable metal stents (SEMSs) are an effective palliative treatment for malignant biliary or duodenal strictures, but endoscopic stenting for combined malignant biliary and duodenal obstruction remains technically difficult.


OBJECTIVE
To evaluate the feasibility and clinical success rate of endoscopic double stent-in-stent placement by using a new duodenal metallic stent for the management of malignant biliary and duodenal obstructions.


METHODS
Prospective, observational clinical feasibility study.


METHODS
Tertiary referral center.


METHODS
Technical and clinical success, complications, midterm outcome.


METHODS
Eight patients with inoperable malignant biliary and duodenal strictures were enrolled. Endoscopic placement of a biliary SEMS was performed through the mesh of the duodenal stent.


RESULTS
The duodenal strictures were in the first part of the duodenum in 3 patients (type 1) and in the second part in 5 patients (type 2). Duodenal stents were successfully deployed in all patients. Endoscopic placement of a biliary SEMS through the mesh of the duodenal stent was successful in 7 (87.5%) of 8 patients. In 2 of 3 patients with type 2 duodenal strictures with failed bile duct cannulation, biliary stenting was successful by using the rendezvous procedure. Early complications occurred in 1 patient. The overall median survival after combined stenting was 91 days (range 36-314 days).


CONCLUSIONS
Small number of patients and no comparison with other enteral stents.


CONCLUSIONS
Biliary stenting through the new duodenal metallic stent is technically feasible and has a high success rate. Combined endoscopic biliary and duodenal stent-in-stent placement is a promising solution for the palliation of malignant biliary and duodenal obstruction.
Moon
Jong Ho
JH
Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea.
Choi
Hyun Jong
HJ
Ko
Bong Min
BM
Koo
Hyun Cheol
HC
Hong
Su Jin
SJ
Cheon
Young Koog
YK
Cho
Young Deok
YD
Lee
Moon Sung
MS
Shim
Chan Sup
CS
D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic; D004067:Digestive System Neoplasms / Q000150:complications*; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D019919:Prosthesis Implantation; D015607:Stents; D016896:Treatment Outcome