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Updated: May 12, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction
Jung-Hoon Park1, Ho-Young Song, Myoung Sun Kim
1Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background:
Self-expandable metallic stent placement is widely used to manage malignant gastroduodenal obstructions. However, there are difficulties in negotiating a guidewire (GW) and a stent delivery system (SDS).
Purpose:
To investigate feasibility, usefulness, and safety of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstructions.
Material And Methods:
In July 2001 to August 2011, 726 patients with malignant gastroduodenal obstructions underwent stent placement. Guiding sheath was used in patients in whom a GW could not be passed through the obstruction and a SDS failed to reach the obstruction. Sheath usefulness was evaluated based on the ability of the sheath to successfully assist. The technical success rate and the most frequent reasons for the use of a sheath were evaluated.
Results:
The guiding sheath was needed in 148 of 726 patients (20%). The overall technical success rate was 98% with the guiding sheath. In two of 148 patients, stent placement failed because, the GW could not be passed through the obstruction, in the other, the SDS could not be passed. A minority of patients reported mild discomfort. Patients with pancreatic cancer and duodenal obstruction were significantly more likely to require the use of guiding sheaths (P = 0.002, P < 0.001, respectively).
Conclusion:
Using a guiding sheath for fluoroscopic stent placement appears to be feasible, useful and safe in patients with malignant gastroduodenal obstructions.
