title: Combined endoscopic stent-in-stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent (with videos).
abstract: 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.
authors: Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Korea.
authors: Jong Ho
authors: JH
authors: Moon
authors: Hyun Jong
authors: HJ
authors: Choi
authors: Bong Min
authors: BM
authors: Ko
authors: Hyun Cheol
authors: HC
authors: Koo
authors: Su Jin
authors: SJ
authors: Hong
authors: Young Koog
authors: YK
authors: Cheon
authors: Young Deok
authors: YD
authors: Cho
authors: Moon Sung
authors: MS
authors: Lee
authors: Chan Sup
authors: CS
authors: Shim
mesh_terms: 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