The surgical management of patients with malignant biliary and
duodenal obstruction is complex.
Tumor excision is no longer possible in the majority of patients with malignant
obstructive jaundice and
duodenal obstruction. The aim of the present study was to evaluate the effectiveness of intraluminal dual
stent placement in malignant biliary and
duodenal obstruction. In total, 20 patients with malignant
obstructive jaundice and
duodenal obstruction, including 6 with
pancreatic carcinoma, 11 with
cholangiocarcinoma, 1 with duodenal
carcinoma and 2 with abdominal
lymph node metastasis, were treated with intraluminal
stent placement.
Bile duct obstruction with late occurrence of
duodenal obstruction was observed in 16 cases, and
duodenal obstruction followed by a late occurrence of
bile duct obstruction was observed in 3 cases, while, in 1 case,
bile duct obstruction and
duodenal obstruction occurred simultaneously. After X-ray fluoroscopy revealed obstruction in the bile duct and duodenum,
stents were placed into the respective lumens. Percutaneous transhepatic placement was employed for the biliary
stent, while the duodenal
stent was placed perioraly. The clinical outcomes, including complications associated with the procedures and patency of the
stents, were evaluated. The biliary and duodenal
stents were successfully implanted in 18 patients and the technical success rate was 90% (18/20). A total of 39
stents were implanted in 20 patients. In 2 cases, duodenal
stent placement failed following biliary
stent placement.
Duodenal obstruction remitted in 15 patients, and 1 patient succumbed to
aspiration pneumonia 5 days after the procedure. No severe complications were observed in any other patient. The survival time of the 18 patients was 5-21 months (median, 9.6 months), and 6 of those patients survived for >12 months. The present study suggests that X-ray fluoroscopy-guided intraluminal
stent implantation is an effective procedure for the treatment of malignant biliary and
duodenal obstruction.