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Radiology Daily
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No Significant Advantage to Standard Placement of Duodenal Stints

January 26, 2008
Written by: , Filed in: Interventional Radiology
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The objective of a recent study was to evaluate the efficacy of palliation of malignant biliary strictures and duodenal obstruction with metallic stents using fluoroscopic guidance.

The study has concluded that combined stenting performed without endoscopic guidance is technically feasible and effective at palliation of biliary and duodenal obstruction.

Participants
In this retrospective analysis, 9 patients (6 men, 3 women) with combined stenting for malignant biliary stricture and duodenal obstruction were evaluated.

Methodology
Data collected included patient demographics, diagnosis, type and number of stents placed, complications, bilirubin levels, and oral intake. All patients were followed until their death.

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 University of California San Francisco Department of Radiology
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Results
20 stents were deployed in 9 patients, for a 100% technical success rate. There was at least a 71% reduction in bilirubin levels, and 1 patient needed repeat biliary stenting for tumor ingrowth. Eight of 9 patients with duodenal stents showed ability to tolerate at least a liquid diet; 1 patient had no improvement. Mean survival periods were 111 days and 73 days following duodenal and biliary stenting, respectively.

Conclusions
Combined stenting performed without endoscopic guidance is technically feasible and effective at palliation of biliary and duodenal obstruction. Percutaneous gastrostomy route may be used for duodenal stenting if oral methods are unsuccessful.

Reviewer’s Comments
Malignant strictures should be stented with metallic endoprosthesis due to better patency rates. Benign strictures should be treated with plastic stents that may be used until the stricture has dilated.

Author: Sohail Contractor, MD

Reference:

Akinci D, Akhan O, et al. Palliation of Malignant Biliary and Duodenal Obstruction With Combined Metallic Stenting. Cardiovasc Intervent Radiol; 2007; 30 (November): 1173-1177

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