Four cases of endoscopic double-metallic stenting for the palliative treatment of malignant biliary and gastric outlet obstruction

Abstract

These cases included one patient with bile duct cancer, two with pancreatic cancer and one with gallbladder cancer. Duodenal SEMS were deployed prior to biliary SEMS in three patients, and the remaining patient was treated in the reverse order. Duodenal SEMS were placed at the oral side of the papilla via the through-the-scope method because the strictures were proximal to the papilla in all patients. Combined endoscopic stenting was successful and no procedure-related complications occurred in any of the patients. One patient developed recurrent GOO due to tumor ingrowth as a late complication, and was treated by re-insertion of another SEMS using the stent-in-stent method 161days after the first SEMS. The QOL of all patients was well-maintained until the time of death. Combined endoscopic biliary and duodenal stenting is a feasible and effective technique for the palliation of malignant GOO and biliary obstruction.