Self-Expanding Metal Stents for Palliative Treatment of Malignant Biliary and Duodenal Stenoses

Abstract

Patients with malignant biliary stenosis due to pancreatic head cancer often have the associated problem of duodenal obstruction. We report here the case of a 78-year-old woman with this clinical situation, who was treated with self-expanding Gianturco metal stents placed in the distal common bile duct and, nine months later, placed in the descending duodenum. The patient's frequent vomiting resolved, and she was able to tolerate peroral solid food; jaundice also decreased (bilirubin pre-stenting: 7.8; post-stenting: 1.2). Self-expanding metal stents therefore appear to be effective for the palliative treatment of malignant duodenal stenosis as well as biliary stenosis.

Role of self-expandable metal stents in the palliation of malignant duodenal obstruction

“…Maetani et al [29] noted that patients with pancreatic cancer who became jaundiced developed duodenal obstruction an average of 9 months later. Clinicians should be aware that enteral stenting for a malignant duodenal obstruction, especially if it involves the second duodenum, may make any future endoscopic approach to the ampulla very difficult and sometimes impossible, causing possible resort to the percutaneous transhepatic approach.…”

Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction

“…An association between the development of jaundice and the subsequent development of duodenal obstruction has been described. Maetani et al [23] described a patient with placement of biliary metal stents for biliary obstruction who later developed gastric outlet obstruction and required duodenal metal stenting. An exclusive category of patients may present with evidence of simultaneous biliary and duodenal obstruction.…”

Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

“…Additionally, the composition of enrolled patients was relatively uniformed (periampullary cancer with most of them were pancreas head cancer), and these strengths are contrasted to the heterogenous characteristics of previously reported data [2][3][4][5][6][7][8][9][10] in terms of adopted SEMS types, endoscopic and interventional techniques, and performed endoscopists and interventional radiologists.…”

“…2,8 An association between the development of jaundice and the subsequent development of duodenal obstruction has been reported. 9 Freeman and Cass 10 referred a case report describing the use of interlocking metal stents for simultaneous treatment of malignant biliary and duodenal obstruction. However, there have been not enough studies looking at the clinical outcome of sequential self-expandable metal stent (SEMS) for malignant biliary obstruction and malignant duodenal obstruction in patients with periampullary cancer.…”