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Updated: Feb 24, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
[Metal self-expanding stents for malignant obstruction of stomach outlet and duodenum]
A V Shabunin1, S S Lebedev1, G M Chechenin1
1Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia.
Aim:
To compare different types of self-expanding stents (partially coated or uncovered) for malignant pyloroduodenal obstruction (MPDO).
Material And Methods:
89 MPDO patients underwent stenting at the Botkin City Hospital (Moscow) for the period 2008-2016. The causes of malignant obstruction were: stomach cancer - 53 (59.5%), pancreatic cancer - 31 (34.8%), compression by retroperitoneal lymph nodes - 3 (3.4%), duodenal cancer - 2 (2.2%). Patients were divided into two homogeneous groups. In group 1 (32 patients) partially coated stents were used, in group 2 (57 patients) - uncovered stents. Mean age was 68.3±6.2 and 64.3±5.7 years in both groups respectively; male/female ratio 18/14 in group 1, 32/25 in group 2. Length of stricture was 51±5.1 mm in group 1, 48±4.8 mm in group 2. GOOSS score in group 1: 0-8, 1-13, 2-11, 3-0, in group 2 0-14, 1-25, 2-18, 3-0 (p=0.03).
Results And Discussion:
Technical success was achieved in 32 patients of group 1 (100%) and in 57 patients of group 2 (100%). There were no procedure-associated complications and mortality. Clinical success was observed in 29 (90.6%) patients of group 1 and in 50 (87.7%) patients of group 2. GOOSS score of group 1: 0-8, 1-8, 2-10, 3-12, group 2: 0-3, 1-15, 2-19, 3-20. There were 3 distal dislocations of the stent within 1 - days in group 1, in group 2 dislocations were absent. Postoperative chemotherapy was prescribed in 20 (62.5%) patients of group 1 and 38 (66.7%) patients of group 2 (p=0.08). 27 patients of group 1 and 49 patients of group 2 died due to progression of the disease, others are under observation. Mean life expectancy: group 1 (18 patients - 50 days, 9 patients - 100 days, 5 patients were alive by the moment of study); group 2 (32 patients - 50 days, 100 days - 17 patients, 8 patients were alive by the moment of study). 3 patients (9.4%) in group 1 and 7 (12.3%) patients in group 2 had stent dysfunction (p=0.02). Mean period of partially covered stent function was 138±3.9 days, uncovered stent - 96±4.8 days (р=0.003).
Conclusion:
Our study showed that time of stent function corresponds to median survival. Greater number of stent migration in group 1 is due to stent coverage, higher incidence of stent dysfunction in group 2 - due to malignant invasion.
Insights
Partially coated stents for malignant pyloroduodenal obstruction (MPDO) showed longer function (138 days) than uncovered stents (96 days), despite increased migration. Uncovered stents had higher dysfunction rates due to malignant invasion.
Area of Science:
- Gastroenterology
- Oncology
- Medical Devices
Background:
- Malignant pyloroduodenal obstruction (MPDO) significantly impacts patient quality of life and survival.
- Self-expanding stents are a primary treatment modality for palliation in MPDO.
- Comparing stent types is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To compare the efficacy and safety of partially coated versus uncovered self-expanding stents in patients with MPDO.
- To evaluate stent patency, migration, dysfunction, and patient survival rates.
Main Methods:
- A retrospective study of 89 MPDO patients treated between 2008-2016.
- Patients were divided into two groups: partially coated stents (n=32) and uncovered stents (n=57).
- Outcomes assessed included technical and clinical success, stent migration, dysfunction, and survival.
Main Results:
- Both stent types achieved 100% technical success and no procedure-related mortality.
- Clinical success rates were high: 90.6% for partially coated and 87.7% for uncovered stents.
- Partially coated stents demonstrated significantly longer function (138 days vs. 96 days, p=0.003) but had more migration (9.4% vs. 0%). Uncovered stents had higher dysfunction (12.3% vs. 9.4%, p=0.02).
Conclusions:
- Partially coated stents offer a longer functional period in MPDO palliation.
- Stent migration is a concern with partially coated stents, while malignant invasion contributes to dysfunction in uncovered stents.
- Stent type selection should consider the trade-off between functional duration and migration/dysfunction risks.
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