Abstract
Duodenal obstruction is often accompanied with unresectable malignant distal biliary obstruction in patients who have undergone biliary self-expandable metal stent (SEMS) placement. Duodenobiliary reflux (DBR) is a major cause of recurrent biliary obstruction (RBO) after covered biliary SEMS placement. We analyzed the risk factors for DBR-related SEMS dysfunction following treatment for malignant duodenal obstruction. Sixty-one patients with covered SEMS who underwent treatment for duodenal obstruction were included. We excluded patients with tumor-related stent dysfunction (n = 6) or metal stent migration (n = 1). Fifty-four patients who underwent covered biliary SEMS placement followed by duodenal metal stenting or surgical gastrojejunostomy were included. Eleven patients had DBR-related biliary SEMS dysfunction after treatment of duodenal obstruction. There was no difference between the duodenal metal stenting group and the surgical gastrojejunostomy group. Duodenal obstruction below the papilla of Vater and a score of ≤2 on the Gastric Outlet Obstruction Scoring System after treatment for duodenal obstruction were associated with DBR-related covered biliary SEMS dysfunction. Thus, creating a reliable route for ensuring good oral intake and avoiding DBR in patients with duodenal obstruction below the papilla of Vater are both important factors in preventing DBR-related covered biliary SEMS dysfunction.
Highlights
Patients with malignant tumors in the periampullary area have an increased risk of dual obstruction in the distal bile duct and duodenum, both of which are considered severe co-morbidities
Fifty-four patients who underwent covered biliary selfexpandable metal stent (SEMS) placement followed by duodenal metal stenting or surgical gastrojejunostomy were included and their data were retrospectively collected
Among the 54 patients with covered biliary SEMS accompanied by duodenal obstruction, 41 patients underwent duodenal SEMS placement and 13 patients underwent surgical gastrojejunostomy
Summary
Patients with malignant tumors in the periampullary area have an increased risk of dual obstruction in the distal bile duct and duodenum, both of which are considered severe co-morbidities. These may be caused by several types of malignant diseases, including local, regional, or metastatic cancer. The possibility of tumor-related recurrent biliary obstruction (RBO) decreases after the use of covered biliary SEMS, another mechanism known as duodenobiliary reflux (DBR) serves as a major cause of RBO [6]. We aimed to analyze the risk factors of DBR-related covered biliary SEMS dysfunction after treatment for duodenal obstruction
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