Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

Akıncı, Devrim; Akhan, Okan; Özkan, Fuat; Çiftçi, Türkmen; Özkan, Orhan Ş.; Karçaaltıncaba, Muşturay; Özmen, Mustafa

doi:10.1007/s00270-007-9045-2

Cited by 26 publications

(31 citation statements)

References 14 publications

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“…Similar technical and clinical results have been reported with both techniques (3,4,11,12,16). Endoscopy supports wire-delivery system and prevents buckling due to redundant stomach or tortuous anatomy (11,17).…”

Section: Discussionsupporting

confidence: 66%

“…Endoscopy supports wire-delivery system and prevents buckling due to redundant stomach or tortuous anatomy (11,17). However, fluoroscopic difficulty of manipulating wire-delivery system can be overcome by advancing a sheath until the obstructed segment or using a transgastric approach (16,17). In this study, transgastric approach was used in six patients in whom transoral approach has failed.…”

Section: Discussionmentioning

confidence: 99%

“…Concomitant obstruction is seen particularly in patients with pancreatic cancer, which causes biliary obstruction in 70%-90% and duodenal obstruction in 15%-20% of patients (16). Combined metallic stenting has been reported as a safe and effective method for palliation of both biliary and gastroduodenal obstruction (16,(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Combined metallic stenting has been reported as a safe and effective method for palliation of both biliary and gastroduodenal obstruction (16,(23)(24)(25). We previously reported our initial experience in nine patients with combined stenting (16).…”

Section: Discussionmentioning

confidence: 99%

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Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Bulut¹,

Çiftçi²,

Akhan³

et al. 2017

Diagn Interv Radiol

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M alignant gastroduodenal obstruction (GDO) is a common and debilitating complication of advanced gastric, duodenal, and pancreatobiliary cancers. It can also be seen due to lymphoma and metastatic spread of other malignancies (1, 2). Patients classically present with abdominal pain, nausea, and vomiting with resulting malnutrition and weight loss (1-3). The majority of patients have a median survival of only 3-6 months (4, 5).Curative surgery is often not possible and palliative surgical procedures might have high complication rates with delayed postoperative gastric emptying and prolonged hospitalization (1,(5)(6)(7)(8).Fluoroscopic or endoscopic placement of covered and uncovered metallic stents has been commonly performed in the palliation of malignant GDO as an alternative to gastrojejunostomy (GJ) with high technical and clinical success and low complication rates (5). However, recurrent obstruction due to tumor ingrowth and stent migration is a drawback of uncovered and covered metallic stents.The purpose of this study is to evaluate safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement using different approaches such as transoral, transgastric, and transhepatic in 53 patients with malignant obstruction. Patients who underwent combined biliary and duodenal stenting were also assessed. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the safety and effectiveness of fluoroscopy-guided gastroduodenal metallic stent placement with different approaches in malignant obstruction. METHODSWe retrospectively assessed 53 patients (33 men and 20 women; mean age, 58.7±15 years) who underwent stent placement between February 2004 and April 2014. All patients had unresectable tumors. The most common causes of obstruction were gastric (38%) and pancreatic cancers (36%). Uncovered self-expandable metallic stents (SEMS) were placed under fluoroscopic guidance. In addition to transoral approach in 46 patients (86.7%), transgastric and transhepatic approaches were used in six patients (11.3%) and one patient (1.8%), respectively. Gastric outlet obstruction scoring system (GOOSS) was used to evaluate oral intake before and after stenting. Patients were followed until death or the end of the study. RESULTSTechnical and clinical success rates were 100% and 92%, respectively. The median stent patency was 76 days (range, 4-985 days). Mean preprocedural GOOSS score of 0.1 increased to postprocedural GOOSS score of 2.42 (P < 0.001). Afferent loop decompression was achieved in one symptomatic patient. Neither mortality nor major complications occurred due to stenting. Stent migration occurred in one patient (2%) and stent obstruction occurred in two patients (4%). Combined biliary and duodenal stenting were performed in 21 patients (40%). Post-stenting GOOSS scores were predictive of survival (P = 0.003). CONCLUSIONFluoroscopic metallic stent placement for palliation of malignant gastroduodenal obstruction is safe and effective with high technica...

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Bulut¹,

Çiftçi²,

Akhan³

et al. 2017

Diagn Interv Radiol

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“…If malignant duodenal obstruction is detected in patients with a biliary stent, the guidewire should not pass through the mesh of the biliary stent, since the duodenal stent may not be sufficiently inflated and the chyme may block the biliary stent. The biliary stent is small and integrative, thus if the mesh cannot be inflated, it will lead to severe deformation (11). In the present study, duodenal stent implantation following PTBS failed in 2 patients, since the guidewire passed through the mesh of the biliary stent, but was unable to pass between the stent and the duodenum.…”

Section: Discussionmentioning

confidence: 83%

Palliation double stenting for malignant biliary and duodenal obstruction

Zhao

Zhang

2015

Experimental and Therapeutic Medicine

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Abstract. The surgical management of patients with malignant biliary and duodenal obstruction is complex. Tumor excision is no longer possible in the majority of patients with malignant obstructive jaundice and duodenal obstruction. The aim of the present study was to evaluate the effectiveness of intraluminal dual stent placement in malignant biliary and duodenal obstruction. In total, 20 patients with malignant obstructive jaundice and duodenal obstruction, including 6 with pancreatic carcinoma, 11 with cholangiocarcinoma, 1 with duodenal carcinoma and 2 with abdominal lymph node metastasis, were treated with intraluminal stent placement. Bile duct obstruction with late occurrence of duodenal obstruction was observed in 16 cases, and duodenal obstruction followed by a late occurrence of bile duct obstruction was observed in 3 cases, while, in 1 case, bile duct obstruction and duodenal obstruction occurred simultaneously. After X-ray fluoroscopy revealed obstruction in the bile duct and duodenum, stents were placed into the respective lumens. Percutaneous transhepatic placement was employed for the biliary stent, while the duodenal stent was placed perioraly. The clinical outcomes, including complications associated with the procedures and patency of the stents, were evaluated. The biliary and duodenal stents were successfully implanted in 18 patients and the technical success rate was 90% (18/20). A total of 39 stents were implanted in 20 patients. In 2 cases, duodenal stent placement failed following biliary stent placement. Duodenal obstruction remitted in 15 patients, and 1 patient succumbed to aspiration pneumonia 5 days after the procedure. No severe complications were observed in any other patient. The survival time of the 18 patients was 5-21 months (median, 9.6 months), and 6 of those patients survived for >12 months. The present study suggests that X-ray fluoroscopy-guided intraluminal stent implantation is an effective procedure for the treatment of malignant biliary and duodenal obstruction. IntroductionBiliary and duodenal obstruction is a common complication in patients with gastroduodenal or pancreatobiliary malignancies. Stent implantation has been widely used in clinical practice, which is the preferred method for palliative management of malignant biliary and duodenal obstruction (1-6). Obstructive jaundice accompanied by duodenal obstruction is mainly caused by periampullary or pancreatic head carcinoma, malignant duodenal tumor and lymph node metastasis. Biliary and duodenal obstruction causes cholestasis and hepatic insufficiency. Patients with malignant obstructive jaundice and duodenal obstruction are in a poor condition or the tumor has already invaded the surrounding tissue or organs, thus tumor excision in no longer possible (7).The most commonly used surgical approach for biliary and duodenal obstruction is palliative cholangioenteric anastomosis, gastroenterostomy or jejunostomy; however, these approaches are not considered safe for patients who are weak, have electrolyte imbalance o...

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Malignant Gastroduodenal Obstruction: Treatment with Self-Expanding Uncovered Wallstent

Gutzeit

Binkert

Schoch

et al. 2008

Cardiovasc Intervent Radiol

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Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

Cited by 26 publications

References 14 publications

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches

Palliation double stenting for malignant biliary and duodenal obstruction

Malignant Gastroduodenal Obstruction: Treatment with Self-Expanding Uncovered Wallstent

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