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Background and Aim <p>The palliative treatment of malignant dual obstruction involving the distal biliary obstruction (DBO) and the gastric outlet obstruction (GOO) presents a complex and common clinical challenge. This study aims to analyze the clinical experience and therapeutic efficacy of endoscopic multi-stent placement in these patients.</p> Patients and Methods <p>We conducted a retrospective cohort study involving 150 patients with unresectable malignancies presenting with concurrent GOO and DBO. All patients underwent endoscopic multi-stent placement at the General Hospital of Northern Theater Command between June 2012 and December 2024. Procedural outcomes include technical success rates, clinical effectiveness, and post-operative complications. Logistic regression analyses were performed to identify independent risk factors associated with suboptimal clinical outcomes following duodenal stenting.</p> Results <p>The cohort comprised 150 patients who underwent a total of 152 endoscopic retrograde cholangiopancreatography (ERCP) procedures for endoscopic multi-stent placement. Procedural outcomes demonstrated varying technical success rates across stent types: 94.5% (142/150) for biliary stents, 100% (150/150) for duodenal stents, and 90% (62/69) for pancreatic stents. Corresponding clinical success rates were 93% (132/142), 87%, and 98% (59/60), respectively. Univariate and stepwise logistic regression analysis identified two significant predictors of duodenal stent dysfunction: metastatic disease burden (OR 3.34, 95% CI 1.12–11.42; <i>p</i> = 0.038) and an obstruction length exceeding 5&#xa0;cm (OR 4.23, 95% CI 1.40–12.74; <i>p</i> = 0.010). The safety profile included procedure-related adverse events: post-ERCP pancreatitis (4%, 6/150), cholangitis (4%, 6/150), perforation (1, 0.67%), and death (7, 4.7%).</p> Conclusion <p>Endoscopic multi-stent placement demonstrated high safety and efficacy for palliating combined malignant GOO and DBO. Tumor metastasis and long-segment obstruction (≥ 5&#xa0;cm) serve as independent predictors of suboptimal efficacy of duodenal stent.</p>

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Endoscopic multi-stent placement for combined malignant gastric outlet and distal biliary obstruction; 12-year experience at a tertiary endoscopic center

  • 期刊论文

  • 发表日期：

    2025年11月12日

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  • Di Zhang,
  • Meng Zhang,
  • Na An,
  • Jinqi Xing,
  • Zihao Dai,
  • Yong Sun,
  • Peng Li,
  • Feng Gao,
  • Jiangning Gu,
  • Zhuo Yang

摘要

Background and Aim

The palliative treatment of malignant dual obstruction involving the distal biliary obstruction (DBO) and the gastric outlet obstruction (GOO) presents a complex and common clinical challenge. This study aims to analyze the clinical experience and therapeutic efficacy of endoscopic multi-stent placement in these patients.

Patients and Methods

We conducted a retrospective cohort study involving 150 patients with unresectable malignancies presenting with concurrent GOO and DBO. All patients underwent endoscopic multi-stent placement at the General Hospital of Northern Theater Command between June 2012 and December 2024. Procedural outcomes include technical success rates, clinical effectiveness, and post-operative complications. Logistic regression analyses were performed to identify independent risk factors associated with suboptimal clinical outcomes following duodenal stenting.

Results

The cohort comprised 150 patients who underwent a total of 152 endoscopic retrograde cholangiopancreatography (ERCP) procedures for endoscopic multi-stent placement. Procedural outcomes demonstrated varying technical success rates across stent types: 94.5% (142/150) for biliary stents, 100% (150/150) for duodenal stents, and 90% (62/69) for pancreatic stents. Corresponding clinical success rates were 93% (132/142), 87%, and 98% (59/60), respectively. Univariate and stepwise logistic regression analysis identified two significant predictors of duodenal stent dysfunction: metastatic disease burden (OR 3.34, 95% CI 1.12–11.42; p = 0.038) and an obstruction length exceeding 5 cm (OR 4.23, 95% CI 1.40–12.74; p = 0.010). The safety profile included procedure-related adverse events: post-ERCP pancreatitis (4%, 6/150), cholangitis (4%, 6/150), perforation (1, 0.67%), and death (7, 4.7%).

Conclusion

Endoscopic multi-stent placement demonstrated high safety and efficacy for palliating combined malignant GOO and DBO. Tumor metastasis and long-segment obstruction (≥ 5 cm) serve as independent predictors of suboptimal efficacy of duodenal stent.