Endoscopic multi-stent placement for combined malignant gastric outlet and distal biliary obstruction; 12-year...

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.

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.

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%).

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.