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Digestive Diseases and Sciences

, Volume 59, Issue 11, pp 2779–2789 | Cite as

Endoscopic Bilio-Duodenal Bypass: Outcomes of Primary and Revision Efficacy of Combined Metallic Stents in Malignant Duodenal and Biliary Obstructions

  • Jorge CanenaEmail author
  • João Coimbra
  • Diana Carvalho
  • Catarina Rodrigues
  • Mário Silva
  • Mariana Costa
  • David Horta
  • António Mateus Dias
  • Isabel Seves
  • Gonçalo Ramos
  • Leonel Ricardo
  • António Pereira Coutinho
  • Carlos Romão
  • Pedro Mota Veiga
Original Article

Abstract

Background

Self-expandable metal stents (SEMSs) can be used for palliation of combined malignant biliary and duodenal obstructions. However, the results of the concomitant stent placement for the duration of the patients’ lives, as well as the need for and efficacy of endoscopic revision, are unclear.

Aim

This study evaluated the clinical effectiveness of SEMS placement for combined biliary and duodenal obstructions throughout the patients’ lives and the need for endoscopic revision.

Methods

This study is a retrospective multicenter study of 50 consecutive patients who underwent simultaneous or sequential SEMS placement for malignant biliary and duodenal obstructions. The data were collected to analyze the sustained relief of obstructive symptoms until the patients’ death and the efficacy of endoscopic revision, as well as stent patency, adverse events, survival and prognostic factors for stent patency.

Results

Technical and immediate clinical success was achieved in all of the patients. Duodenal stricture occurred before the papilla in 35 patients (70 %), involved the papilla in 11 patients (22 %) and was observed distal to the papilla in four patients (8 %). Initial biliary stenting was performed endoscopically in 42 patients (84 %) and percutaneously in eight patients. After combined stenting, 30 patients (60 %) required no additional intervention until the time of their death. The remaining 20 patients were successfully treated using endoscopic stent reinsertion: nine patients needed biliary revision, three patients needed duodenal restenting and eight patients needed both biliary and duodenal reinsertion. The median duodenal stent patency and median biliary stent patency were 34 and 27 weeks, respectively. The median survival after combined stent placement was 18 weeks. A Cox multivariate analysis showed that duodenal stent obstruction after combined stenting was a risk factor for biliary stent obstruction (hazard ratio 6.85; 95 % confidence interval 1.43–198.98; P = 0.025).

Conclusions

Endoscopic bilio-duodenal bypass is clinically effective, and the majority of the patients need no additional intervention until their death. Endoscopic revision is feasible and has a high success rate.

Keywords

Self-expandable metal stents Duodenal obstruction Biliary obstruction Combined stenting Bilio-duodenal bypass 

Notes

Conflict of interest

Jorge Canena is a consultant for Boston Scientific. All other authors disclose no financial relationships relevant to this article.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jorge Canena
    • 1
    • 2
    • 3
    • 4
    Email author
  • João Coimbra
    • 1
  • Diana Carvalho
    • 1
  • Catarina Rodrigues
    • 2
  • Mário Silva
    • 1
  • Mariana Costa
    • 1
  • David Horta
    • 2
  • António Mateus Dias
    • 1
  • Isabel Seves
    • 1
  • Gonçalo Ramos
    • 1
  • Leonel Ricardo
    • 2
  • António Pereira Coutinho
    • 3
  • Carlos Romão
    • 3
  • Pedro Mota Veiga
    • 5
  1. 1.Department of Gastroenterology, Santo António dos Capuchos Hospital do Centro Hospitalar Lisboa CentralNova Medical School-Faculty of Medical SciencesLisbonPortugal
  2. 2.Department of GastroenterologyProfessor Doutor Fernando Fonseca HospitalAmadoraPortugal
  3. 3.Department of GastroenterologyPulido Valente Hospital do Centro Hospitalar Lisboa NorteLisbonPortugal
  4. 4.Department of EndoscopyJosé Joaquim Fernandes Hospital da Unidade Local de Saúde do Baixo AlentejoBejaPortugal
  5. 5.Curva de Gauss – Research, Training and ConsultingCanas de SenhorimPortugal

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