Review Open Access
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2019; 11(2): 53-61
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.53
Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature
Benedetto Mangiavillano, Francesco Auriemma, Mario Bianchetti, Gastrointestinal Endoscopy Unit; Humanitas - Mater Domini, Castellanza 21053, Italy
Benedetto Mangiavillano, Alessandro Repici, Humanitas Huniversity, Hunimed, Pieve Emanuele, Milano 20090, Italy
Mouen A Khashab, Yen-I Chen, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland, Baltimore 21218, United States
Ilaria Tarantino, Mario Traina, Gastroenterology and Endoscopy Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo 90100, Italy
Silvia Carrara, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
Rossella Semeraro, Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Rozzano 20089, Italy
Leonardo Henry Eusebi, Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna 40138, Italy
Luca De Luca, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Pesaro 61122, Italy
Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano 20089, Italy
ORCID number: Benedetto Mangiavillano (0000-0003-0611-7448); Mouen A Khashab (0000-0001-5085-7908); Ilaria Tarantino (0000-0001-8791-3395); Silvia Carrara (0000-0003-4206-9463); Rossella Semeraro (0000-0002-2336-2448); Francesco Auriemma (0000-0002-2911-3098); Mario Bianchetti (0000-0001-9476-640X); Leonardo Henry Eusebi (0000-0003-3323-7744); Chen Yen-I (0000-0001-5704-2226); Luca De Luca (0000-0002-3290-3103); Mario Traina (0000-0001-5041-0858); Alessandro Repici (0000-0002-1621-6450).
Author contributions: Mangiavillano B, Auriemma F, Chen YI and De Luca D designed research and wrote, edited and finalized the text; Bianchetti M, Semeraro R and Carrara S performed literature search and analyzed the data; Eusebi LH corrected the English form; Repici A, Khashab MA and Traina M reviewed the paper for important intellectual content.
Conflict-of-interest statement: No conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Benedetto Mangiavillano, MD, Chief Doctor, Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Via Gerenzano n.2, Milano, MI 20149, Italy. b_mangiavillano@hotmail.com
Telephone: +39-331-476205381
Received: December 8, 2018
Peer-review started: December 10, 2018
First decision: December 24, 2018
Revised: December 30, 2018
Accepted: January 23, 2019
Article in press: January 23, 2019
Published online: February 27, 2019
Processing time: 80 Days and 17.8 Hours

Abstract

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary, peri-ampullary, and pancreatic head neoplasia. Surgical bypass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique, with a high technical success in expert hands. In recent years, endoscopic ultrasonography (EUS) has evolved from a diagnostic to a therapeutic procedure, and is now increasingly used to guide biliary drainage, especially in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). The advent of lumen-apposing metal stents (LAMS) has expanded EUS therapeutic options, and changed the management of synchronous bilioduodenal stenosis. The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach, also considering the advent of an interventional EUS approach using LAMS.

Key Words: Malignant biliary strictures; Malignant duodenal stenosis; Bilio-duodenal stenosis; Biliary self-expandable metal stent; Duodenal self-expandable metal stent; Lumen-apposing metal stents; Gastro-jejunostomy

Core tip: Concomitant biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected by ampullary, peri-ampullary and pancreatic head neoplasia. Surgical by-pass is no longer the gold-standard therapy for these patients, as simultaneous endoscopic biliary and duodenal stenting is a nowadays a feasible and widely used technique, with a high technical success in expert hands. The most recent literature regarding endoscopic treatments for concomitant biliary and duodenal malignant stenosis has been reviewed, to determine the best endoscopic approach considering also the advent of interventional endoscopic ultrasonography approach using lumen apposing metal stents.



INTRODUCTION

Ampullary and periampullary malignant diseases, such as pancreatic cancer, cholangiocarcinoma, gallbladder cancer, and peripancreatic metastatic lesions are usually diagnosed at an advanced stage in which surgery is no longer indicated or the patients are unfit for surgical resection. Therefore, the treatments these patients can undergo are only palliative and, in some cases, chemotherapy is not indicated due to an end-stage disease. The survival of these patients is often not longer than 6 mo[1,2]. Ampullary and periampullary malignant disease can cause biliary or duodenal obstruction, and in previous case series between 6% and 9% of patients, following the placement of plastic stents for malignant biliary obstruction, developed a duodenal obstruction requiring surgical palliation with a gastrojejunostomy (GJS)[3]. Today, in the presence of a duodenal stenosis, the endoscopic stenting is preferred to the GJS, in the treatment for palliation of the gastric outlet obstruction (GOO), also because of the lower procedural costs and lesser hospital stay[4,5], even if readmission and mortality rates can be similar[6]. The advent of the self-expandable metal stent (SEMS) has widened the therapeutic options, increasing the quality of life for these patients. The same consideration can be made for the malignant biliary obstructions for which the hepaticojejunostomy has been supplanted by biliary SEMS placement. The clinical success rate of duodenal SEMS placement in patients affected by GOO is from 84% to 93%, and a technical success rate ranging between 93% and 97%[7-9].Over and tissue ingrowth, SEMS displacement, impaction of solid food can be possible adverse events after self-expandable stent placement. This eventuality require further endoscopic intervention in the 20%-25% of these patients[10].

The treatment can be even more challenging when biliary and duodenal obstruction arise simultaneously. We aimed to systematically evaluate the published literature on the endoscopic approaches to bilioduodenal stenosis, also taking into account the advent of the EUS approach to the biliary tree using the lumen-apposing metal stents (LAMS).

LITERATURE SEARCH

A search of the literature was done in order to identify studies including patients with synchronous biliary and duodenal stenosis, published from January 1st 2000 until June 2018, using the main electronic databases (PubMed, Scopus, and Google Scholar and the Cochrane Library). The medical literature was searched using the following keywords: Biliary stenosis, duodenal stenosis, stenting, self-expanding metallic stent, SEMS, lumen-apposing metal stent, and LAMS. Only studies in English were evaluated. Studies considering outcomes of non- synchronous biliary and duodenal stenosis were excluded.

ROLE OF ERCP IN THE MANAGEMENT OF SYNCHRONOUS BILIARY AND DUODENAL STENOSIS
Technique

A proposed classification of synchronous malignant bilioduodenal stenosis was proposed by Mutignani et al[11] in 2007. Three different types of synchronous bilioduodenal stenosis have been described based on clinical scenarios: type I, in which duodenal strictures are present in the duodenal bulb or in the duodenal genu; type II, in which the duodenal stenosis involves the papilla; and type III, in which duodenal stenosis occurs distally from the papilla, without its involvement. On the basis of this classification, the type of synchronous biliary stenosis determines the endoscopic palliative approach.

The most difficult scenarios for draining the biliary tree usually occur in the presence of the type I or II synchronous duodenal stricture. Nevertheless, if the duodenoscope passes through the duodenal stricture, endoscopic retrograde cholangiopancreatography (ERCP) can be performed, whereas if the duodenoscope does not pass across the stricture a duodenal uncovered metal stent has to be deployed. The common bile duct (CBD) is cannulated through the mesh of the duodenal stent and, after the sphincterotomy, the duodenal mesh can be dilated by pneumatic dilation. If the papilla is “jailed” by the enteral stent, argon plasma coagulation or rat-tooth forceps can be used to trim the enteral mesh to gain access to the ampulla.

Evidence

Currently, there are published studies stating that biliary stenting should not be attempted due to duodenal stenosis. The reported technical success of duodenal and biliary stent insertion in synchronous bilioduodenal stenosis ranges from 82.1% to 94.4%. The literature search found three prospective studies and eight retrospective studies regarding the efficacy of combined biliary and duodenal stenting during the same session (Table 1)[12-20]. The only prospective study is by Mutignani et al[11], and was published in 2007. It comprised a consecutive series of 64 patients, of whom 14 had concurrent biliary and duodenal obstruction. Duodenal SEMS occlusion, after concomitant bilioduodenal stenting is not dependently associated with a higher risk of biliary occlusion of the SEMS; however, the majority of patients do not require further re-intervention for stent occlusion.

Table 1 Results of the studies in which endoscopic retrograde cholangiopancreatography and upper operative endoscopy for the treatment of bilio-duodenal malignant stenosis were performed.
Ref.Study designInterventionPatient (n)Technical success n (%)Clinical success n (%)Adverse events
Kaw et al[12], 2003RetrospectiveCombined biliary and duodenal stenting18 (18 concomitant)17/18 (94.4)16/17 (94.1)None
Profili et al[12], 2003Case seriesCombined biliary and duodenal stenting4 (4 concomitant)4/4 (100)4/4 (100)In one case transient increase of amylase and lipase
Vanbiervliet et al[19], 2004ProspectiveBiliary stents were placed in patients previously treated with duodenal stents1817/18 (94.4)17/18 (94.4)None
Maire et al[13], 2006RetrospectiveCombined biliary and duodenal stenting100 (23 with bilio-duodenal stenosis; 6 concomitant)21/23 (91) (the study reports the overall technical success)21/21 (100)None
Mutignani et al[11], 2007ProspectiveCombined biliary and duodenal stenting64 (14 concomitant)10/14 (71.4)Not reported only for the patients undergone concomitant bilio-duodenal stentingCholecistitis (1 patient): 10%
Moon et al[18], 2009ProspectiveCombined biliary and duodenal stenting8 (8 concomitant)8/8 (100) (Duodenal stent); 7/8 (87.5) (Biliary stent)7/7 (100)1/8 (12.5%) mild pancreatitis
Katsinelos et al[14], 2010RetrospectiveCombined biliary and duodenal stenting39 (7 concomitant)32/37 (82) (the study report the overall technical success)Not reported only for the patients undergone concomitant bilio-duodenal stenting3/32 (9.3%) post-sphincterotomy bleeding
Hamada et al[16], 2011RetrospectiveCombined biliary and duodenal stenting18 (4 concomitant)4/4 (100)Not reported only for the patients undergone concomitant bilio-duodenal stentingNR
Tonozuka et al[17], 2013RetrospectiveCombined biliary and duodenal stenting11 (11 concomitant: 8 EUS-BD and 3 ERCP-BD)3/3 (100)3/3 (100)No adverse events
Canena et al[15], 2014RetrospectiveCombined biliary and duodenal stenting50 (15 concomitant)13/15 (86.7)Not reported only for the patients undergone concomitant bilio-duodenal stentingNot reported only for the patients undergone concomitant bilio-duodenal stenting

At present, the largest series of patients with synchronous bilio-duodenal malignant strictures comes from the Japanese group of Hori et al[21], published in 2018. They retrospectively evaluated a total of 109 patients. The authors reported a technical success for resolution of synchronous bilioduodenal strictures of 99.1%, with an improvement of symptoms for biliary and duodenal obstruction of 81.7%. The rate of recurring biliary obstruction was 22.9%, and that of recurring duodenal obstruction was 11.9%, with a median time of 87 and 76 d, respectively. In the multivariable analysis, the significant data that emerged from this study was that duodenal uncovered SEMS was significantly associated with recurrent biliary obstruction. On the other hand, no predictive factors for recurrent duodenal obstruction were found, and the type of the duodenal SEMS was not associated with the duodenal obstruction time.

Synchronous bilioduodenal stenting was first reported in 1994[22]. Duodenal FCSEMSs carry a risk of obstructive jaundice, or pancreatitis, because of the possibility of the stent to cover the papilla by the covering of the FCSEMS. Though the effectiveness and safety of placement of a fully-covered SEMS (FCSEMS) across the major papilla has been reported[23], to our knowledge, no published manuscript comparing the clinical outcomes of duodenal uncovered SEMS vs FCSEMS in patients affected by synchronous bilioduodenal malignant strictures have been published. Hamada et al[24] showed as the placement of a duodenal stent is a risk factor for the dysfunction of a biliary SEMS, likely caused by increased duodeno-biliary reflux.

ROLE OF EUS IN THE MANAGEMENT OF SYNCHRONOUS BILIARY AND DUODENAL STENOSIS: EUS AS RESCUE THERAPY WHEN ERCP FAILS

In the last years, endoscopic ultrasonography (EUS) has widely changed from a diagnostic to a therapeutic tool, and is now progressively more performed for the endoscopic biliary drainage (BD) in cases of failed attempt of ERCP[25-26].

Technique

In the management of EUS drainage, for the linear-array echoendoscope, with a 3.8 mm diameter channel, must be used because it allows the passage of large accessories. Two possible puncture routes for EUS-BD can be performed: trans-gastric for left intrahepatic bile duct drainage or the trans-duodenal (from the bulb) for the drainage of the extrahepatic bile duct.

Two major EUS-guided approaches have been used: the transgastric intrahepatic approach and the transduodenal extrahepatic approaches, the latters with 3 different techniques: (1) EUS-guided choledochoduonenostomy; (2) EUS-guided transduodenal extrahepatic or EUS-guided rendez-vous technique (EUS-RV); and (3) EUS-guided biliary antegrograde stenting. EUS-RV is indicated in the patients with a previous failed attempt of ERCP but presents a good endoscopic access to the Vater’s papilla or to the anastomosic site. Different to the trans-luminal stenting, EUS-RV conserve the anatomical integrity of the biliary ducts and without creating a fistula between the biliary duct and the duodenal lumen.

Performing EUS drainage, the use of the color Doppler is mandatory to identify the possible interposed vessels between the lumen wall and the selected duct. The selected duct can be punctured, for the drainage, with a 19- or 22-gauge (G) needle. The 19 G needle is preferable because it allows the passage of a 0.035-inch guide-wire, which provides more stiffness. The 22 G needle lodges only a 0.018-inch guide-wire, which presents a major risk of displacement during the accessories exchanges. After accessing the selected duct with the 19 G or the 22 G needle, injection of a contrast medium can be useful to perform a cholangiogram to confirm the correct position of the needle inside the duct, and to clearly identify the stricture. Thereafter, using X-ray guidance, the guide-wire is advanced in the duct through the needle[27-31].

If the chosen drainage is transmurally from the gastric wall, the intrahepatic ducts of the left liver side can be drained [hepaticogastrostomy (HGS)], while if the chosen duct is the CBD, the drainage can be performed from the bulb [choledochoduodenostomy (CDS)]. CDS can be performed using LAMS, which do not necessarily require the placement of a guidewire, obtaining direct access into the CBD when dilated. If the guidewire exits the ampulla, ERCP can be done to complete the drainage, using the rendez-vous technique. When the release of the LAMS is performed through the puncture route or across the stenosis or the papilla in an anterograde way, different accessories could be used to enlarge the punctured site, as the bougies (6 or 7 Fr), the balloons for pneumatic dilation (4 or 6 mm) or a cystotome (8.5 Fr). However, the use of LAMS has currently supplanted this route and has now become the main technique for BD. Both plastic and metal stents are used for HGS or choledoco-duodenostomy, though the partially-covered and fully-covered SEMS (FCSEMS) are most often used to prevent stent migration and bile leakage.

LAMS have recently changed the management of synchronous bilioduodenal stenosis. EUS biliary drainage is a salvage therapy reserved for type I and type II bilioduodenal stenosis when ERCP fails or as primary modality, especially if there is synchronous GOO and in patients with distorted anatomy. In malignant biliary obstruction (MBO) with synchronous GOO, ERCP may not be possible because the papilla cannot be reached[32].

EUS-BD is generally performed using a direct transluminal approach. Less frequently, the antegrade approach is used. If enteral stenting is needed for synchronous GOO to allow the passage of a duodenoscope, ERCP is the preferred way to approach the CBD, despite high failure rates[33]. In these cases, EUS-BD can be considered a primary approach (Figure 1). The two possible EUS approaches are the CDS and HGS. Literature data on EUS-BD report an acceptable technical and clinical success. In a systematic review involving 1192 patients in 42 studies, EUS-BD was shown to have a technical and clinical success rate of 94.7% and 91.7%, respectively[34]. These data were recently confirmed in an international multicenter prospective series, where technical and clinical success rates were 95.8% and 89.5%, respectively, with an adverse event rate of 10.5%[35]. However, in consideration of the significant rates of adverse events with EUS-BD, ERCP remains the standard of care for the management of biliary obstruction, with EUS-BD as a rescue modality when ERCP fails. In the presence of malignant biliary obstruction with synchronous GOO, EUS-BD or percutaneous transhepatic biliary drainage (PTBD) can be considered the first-line treatments. In these cases, the majority of centers prefer PTBD to EUS-BD because of the higher expertise and experience of the radiologist in performing the procedure compared with the endoscopist performing EUS-BD.

Figure 1
Figure 1 Radiological features of a lumen-apposing metal stent placed with endoscopic ultrasonography choledoco-duodenostomy with a duodenal self-expandable metal stent in a synchronous bilio-duodenal stenosis. LAMS: Lumen-apposing metal stent; SEMS: Self-expandable metal stent.
Evidence

Literature data comparing EUS-BD with PTBD in patients with MBO have shown comparable technical success rates (94.1% for EUS-BD vs 96.9% for PTBD) and clinical success (87.5% for EUS-BD and 87.1% for PTBD), but with fewer adverse events for EUS-BD (8.8% for EUS-BD vs 31.2% for PTBD, P = 0.022)[36]. Nevertheless, overall comparative studies of the two modalities appear to favor EUS-BD[37,38]. Moreover, the major advantage of EUS-BD compared with PTBD is the possibility of performing the procedure during the same session of the failed ERCP[39]. Overall, EUS-BD appears to be an important therapeutic option in the management of MBO in the presence of synchronous GOO, and the major limitation of the implementation of EUS-BD is a lack of expertise. Recent developments, such as the one-step LAMS for EUS-BD, make the procedure easier and safer. In a systematic review of prospective and retrospective series, including series in which the EUS-BD was performed in two steps, the adverse event rate was 23.3%, including peritonitis 1.3%, bleeding 4%, cholangitis 2.4%, pneumoperitoneum 3%, bile leakage 4%, stent migration 2.7% and abdominal pain 1.5%[31]. The recent advent of LAMS and the one-step EUS-BD stent system has increased the safety of EUS-BD, with an overall rate of adverse events reported as ranging from 7% to 10.5%[40]. Results of the studies in which EUS for the treatment of bilio-duodenal malignant stenosis was performed are summarized in Table 2[41-51].

Table 2 Results of the studies in which endoscopic ultrasonography for the treatment of bilio-duodenal malignant stenosis was performed.
Ref.Study designInterventionPatient (n)Technical success n (%)Clinical success n (%)Adverse events
Giovannini et al[41], 2001Case reportEUS-guided biliary drainage (failed)11 (100%)1 (100%)None
Placement through the duodenum of a 10-F plastic stent
Iwamuro et al[42], 2010RetrospectiveEUS-guided combined biliary and duodenal stent placement77 (100%)7 (100%)2 bile leakage
Binmoeller et al[44], 2012Case reportEUS-guided choledocododenostomy + overlapping self-expanding metal enteral stent11 (100%)1 (100%)None
Itoi et al[43], 2012RetrospectiveOnly stent placement under EUS guidance1515 (100%)15 (100%)1 stent migration
Khashab et al[46], 2015RetrospectiveEUS-guided gastroenterostomy98 (90%)8 (90%)None
Glessing et al[49], 2015Case reportEUS guided combined biliary and duodenal stent placement11 (100%)1 (100%)None
Anderloni et al[47], 2016Case seriesEndoscopic ultrasound-guided biliary drainage (Single-session double-stent placement biliary and duodenal stent)44 (100%)4 (100%)None
Belletrutti et al[51], 2010Case reportTransduodenal EUS-guided biliary drainage performed through an existing enteral wall stent11 (100%)1 (100%)None
Rai et al[50], 2018RetrospectiveEndoscopic ultrasound-guided choledochoduodenostomy3028/30 (93.3%)28/28 (100%)3: 1 bile leak, 1 hemobilia, 1 stent block

Stent migration is another potential serious adverse event of EUS-BD, especially in the setting of HGS. This risk can be minimized by ensuring appropriate stent length and avoiding the placement of partially covered metal stents. If stent migration occurs, any collection should be drained via an interventional radiology approach. Finally, patients with cholangitis or bleeding following EUS-BD should also be managed by a multidisciplinary team, including a radiologist performing PTBD for cholangitis and for embolization, with surgical backup for refractory bleeding.

CONCLUSION

Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with periampullary neoplasia. Surgical bypass has long been the gold standard therapy for these patients. Synchronous endoscopic biliary and duodenal stenting is a feasible technique, with a high rate of technical success. ERCP plus duodenal stenting is currently the preferred endoscopic therapy for these patients. We suggest performing endoscopic transpapillary biliary drainage before duodenal stent insertion if the duodenoscope can pass through the duodenal stricture, whereas, if the duodenal stricture cannot be passed, deploying an uncovered duodenal metal stent across the stricture before performing ERCP is recommended. EUS-BD should be performed by expert operators in cases of type I and type II bilio-duodenal stenosis according to the Mutignani classification, when the ERCP fails or as primary modality in patients with distorted anatomy. Optimal clinical results and a low number of patients with this condition reported in the published series discussed in this paper should underline a possible bias. The future development of dedicated accessories and instruments, supported by further data, can contribute to the continual evolution of EUS-BD, which could become the first-line treatment option in patients with MBO in the near future.

Footnotes

Manuscript source: Invited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: Italy

Peer-review report classification

Grade A (Excellent): 0

Grade B (Very good): B, B

Grade C (Good): 0

Grade D (Fair): 0

Grade E (Poor): 0

P- Reviewer: Martini F, Demetrashvili Z S- Editor: Dou Y L- Editor: A E- Editor: Song H

References
1.  Baron TH. Management of simultaneous biliary and duodenal obstruction: the endoscopic perspective. Gut Liver. 2010;4 Suppl 1:S50-S56.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 33]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
2.  Conio M, Mangiavillano B, Caruso A, Filiberti RA, Baron TH, De Luca L, Signorelli S, Crespi M, Marini M, Ravelli P, Conigliaro R, De Ceglie A. Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: a randomized multicenter study. Gastrointest Endosc. 2018;88:283-291.e3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 60]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
3.  Shepherd HA, Royle G, Ross AP, Diba A, Arthur M, Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988;75:1166-1168.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Yoshida Y, Fukutomi A, Tanaka M, Sugiura T, Kawata N, Kawai S, Kito Y, Hamauchi S, Tsushima T, Yokota T, Todaka A, Machida N, Yamazaki K, Onozawa Y, Yasui H. Gastrojejunostomy versus duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer. Pancreatology. 2017;17:983-989.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 27]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
5.  Jeurnink SM, Polinder S, Steyerberg EW, Kuipers EJ, Siersema PD. Cost comparison of gastrojejunostomy versus duodenal stent placement for malignant gastric outlet obstruction. J Gastroenterol. 2010;45:537-543.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 57]  [Cited by in F6Publishing: 65]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
6.  Bliss LA, Eskander MF, Kent TS, Watkins AA, de Geus SW, Storino A, Ng SC, Callery MP, Moser AJ, Tseng JF. Early surgical bypass versus endoscopic stent placement in pancreatic cancer. HPB (Oxford). 2016;18:671-677.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 19]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
7.  Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36:543-550.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 336]  [Cited by in F6Publishing: 286]  [Article Influence: 14.3]  [Reference Citation Analysis (1)]
8.  van Hooft JE, Uitdehaag MJ, Bruno MJ, Timmer R, Siersema PD, Dijkgraaf MG, Fockens P. Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc. 2009;69:1059-1066.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 148]  [Cited by in F6Publishing: 147]  [Article Influence: 9.8]  [Reference Citation Analysis (0)]
9.  Laasch HU, Martin DF, Maetani I. Enteral stents in the gastric outlet and duodenum. Endoscopy. 2005;37:74-81.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 37]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
10.  Mangiavillano B, Pagano N, Arena M, Miraglia S, Consolo P, Iabichino G, Virgilio C, Luigiano C. Role of stenting in gastrointestinal benign and malignant diseases. World J Gastrointest Endosc. 2015;7:460-480.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 26]  [Cited by in F6Publishing: 19]  [Article Influence: 2.1]  [Reference Citation Analysis (1)]
11.  Mutignani M, Tringali A, Shah SG, Perri V, Familiari P, Iacopini F, Spada C, Costamagna G. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy. 2007;39:440-447.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 139]  [Cited by in F6Publishing: 131]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
12.  Kaw M, Singh S, Gagneja H. Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction. Surg Endosc. 2003;17:457-461.  [PubMed]  [DOI]  [Cited in This Article: ]
13.  Maire F, Hammel P, Ponsot P, Aubert A, O'Toole D, Hentic O, Levy P, Ruszniewski P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006;101:735-742.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 130]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
14.  Katsinelos P, Kountouras J, Germanidis G, Paroutoglou G, Paikos D, Lazaraki G, Pilpilidis I, Chatzimavroudis G, Fasoulas K, Zavos C. Sequential or simultaneous placement of self-expandable metallic stents for palliation of malignant biliary and duodenal obstruction due to unresectable pancreatic head carcinoma. Surg Laparosc Endosc Percutan Tech. 2010;20:410-415.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 19]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
15.  Canena J, Coimbra J, Carvalho D, Rodrigues C, Silva M, Costa M, Horta D, Mateus Dias A, Seves I, Ramos G, Ricardo L, Coutinho AP, Romão C, Veiga PM. Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions. Dig Dis Sci. 2014;59:2779-2789.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 18]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
16.  Hamada T, Isayama H, Nakai Y, Togawa O, Kogure H, Kawakubo K, Tsujino T, Sasahira N, Hirano K, Yamamoto N, Arizumi T, Ito Y, Matsubara S, Sasaki T, Yagioka H, Yashima Y, Mohri D, Miyabayashi K, Mizuno S, Nagano R, Takahara N, Toda N, Tada M, Omata M, Koike K. Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer. Gastrointest Endosc. 2011;74:548-555.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 67]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
17.  Tonozuka R, Itoi T, Sofuni A, Itokawa F, Moriyasu F. Endoscopic double stenting for the treatment of malignant biliary and duodenal obstruction due to pancreatic cancer. Dig Endosc. 2013;25 Suppl 2:100-108.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 47]  [Article Influence: 4.3]  [Reference Citation Analysis (0)]
18.  Moon JH, Choi HJ, Ko BM, Koo HC, Hong SJ, Cheon YK, Cho YD, Lee MS, Shim CS. Combined endoscopic stent-in-stent placement for malignant biliary and duodenal obstruction by using a new duodenal metal stent (with videos). Gastrointest Endosc. 2009;70:772-777.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 50]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
19.  Vanbiervliet G, Demarquay JF, Dumas R, Caroli-Bosc FX, Piche T, Tran A. Endoscopic insertion of biliary stents in 18 patients with metallic duodenal stents who developed secondary malignant obstructive jaundice. Gastroenterol Clin Biol. 2004;28:1209-1213.  [PubMed]  [DOI]  [Cited in This Article: ]
20.  Profili S, Feo CF, Meloni GB, Strusi G, Cossu ML, Canalis GC. Combined biliary and duodenal stenting for palliation of pancreatic cancer. Scand J Gastroenterol. 2003;38:1099-1102.  [PubMed]  [DOI]  [Cited in This Article: ]
21.  Hori Y, Naitoh I, Hayashi K, Kondo H, Yoshida M, Shimizu S, Hirano A, Okumura F, Ando T, Jinno N, Takada H, Togawa S, Joh T. Covered duodenal self-expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction. J Gastroenterol Hepatol. 2018;33:696-703.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
22.  Maetani I, Ogawa S, Hoshi H, Sato M, Yoshioka H, Igarashi Y, Sakai Y. Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenoses. Endoscopy. 1994;26:701-704.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 51]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
23.  Poincloux L, Goutorbe F, Rouquette O, Mulliez A, Goutte M, Bommelaer G, Abergel A. Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents. Surg Endosc. 2016;30:437-445.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 12]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
24.  Hamada T, Nakai Y, Isayama H, Sasaki T, Kogure H, Kawakubo K, Sasahira N, Yamamoto N, Togawa O, Mizuno S, Ito Y, Hirano K, Toda N, Tada M, Koike K. Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: an analysis using a time-dependent covariate. Surg Endosc. 2013;27:1243-1248.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 47]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
25.  Fuccio L, Attili F, Vanella G, Larghi A. Interventional endoscopic ultrasonography. Curr Treat Options Gastroenterol. 2014;12:183-210.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 9]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
26.  Fuccio L, Attili F, Larghi A. Forward-viewing linear echoendoscope: a new option in the endoscopic ultrasound armamentarium (with video). J Hepatobiliary Pancreat Sci. 2015;22:27-34.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
27.  Mangiavillano B, Pagano N, Baron TH, Arena M, Iabichino G, Consolo P, Opocher E, Luigiano C. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World J Gastrointest Endosc. 2016;8:143-156.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 38]  [Cited by in F6Publishing: 41]  [Article Influence: 5.1]  [Reference Citation Analysis (0)]
28.  Binmoeller KF, Nguyen-Tang T. Endoscopic ultrasound-guided anterograde cholangiopancreatography. J Hepatobiliary Pancreat Sci. 2011;18:319-331.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 20]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
29.  Itoi T, Isayama H, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Tsuji S, Ishii K, Ikeuchi N, Tanaka R, Umeda J, Moriyasu F, Kawakami H. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. J Hepatobiliary Pancreat Sci. 2011;18:664-672.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 70]  [Cited by in F6Publishing: 68]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
30.  Perez-Miranda M, Barclay RL, Kahaleh M. Endoscopic ultrasonography-guided endoscopic retrograde cholangiopancreatography: endosonographic cholangiopancreatography. Gastrointest Endosc Clin N Am. 2012;22:491-509.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 12]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
31.  Kahaleh M, Artifon EL, Perez-Miranda M, Gupta K, Itoi T, Binmoeller KF, Giovannini M. Endoscopic ultrasonography guided biliary drainage: summary of consortium meeting, May 7th, 2011, Chicago. World J Gastroenterol. 2013;19:1372-1379.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 61]  [Cited by in F6Publishing: 58]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
32.  Poincloux L, Rouquette O, Buc E, Privat J, Pezet D, Dapoigny M, Bommelaer G, Abergel A. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy. 2015;47:794-801.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 102]  [Cited by in F6Publishing: 126]  [Article Influence: 14.0]  [Reference Citation Analysis (0)]
33.  Khashab MA, Valeshabad AK, Leung W, Camilo J, Fukami N, Shieh F, Diehl D, Attam R, Vleggaar FP, Saxena P, Freeman M, Kalloo A, Siersema PD, Sherman S. Multicenter experience with performance of ERCP in patients with an indwelling duodenal stent. Endoscopy. 2014;46:252-255.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 34]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
34.  Wang K, Zhu J, Xing L, Wang Y, Jin Z, Li Z. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc. 2016;83:1218-1227.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 203]  [Cited by in F6Publishing: 209]  [Article Influence: 26.1]  [Reference Citation Analysis (0)]
35.  Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP, Fabbri C, Tarantino I, Varadarajulu S, Modayil RJ, Stavropoulos SN, Peñas I, Ngamruengphong S, Kumbhari V, Romagnuolo J, Shah R, Kalloo AN, Perez-Miranda M, Artifon EL. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open. 2016;4:E487-E496.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 47]  [Cited by in F6Publishing: 51]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
36.  Lee TH, Choi JH, Park do H, Song TJ, Kim DU, Paik WH, Hwangbo Y, Lee SS, Seo DW, Lee SK, Kim MH. Similar Efficacies of Endoscopic Ultrasound-guided Transmural and Percutaneous Drainage for Malignant Distal Biliary Obstruction. Clin Gastroenterol Hepatol. 2016;14:1011-1019.e3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 145]  [Article Influence: 18.1]  [Reference Citation Analysis (0)]
37.  Khashab MA, Valeshabad AK, Afghani E, Singh VK, Kumbhari V, Messallam A, Saxena P, El Zein M, Lennon AM, Canto MI, Kalloo AN. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60:557-565.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 134]  [Cited by in F6Publishing: 153]  [Article Influence: 17.0]  [Reference Citation Analysis (0)]
38.  Sharaiha RZ, Kumta NA, Desai AP, DeFilippis EM, Gabr M, Sarkisian AM, Salgado S, Millman J, Benvenuto A, Cohen M, Tyberg A, Gaidhane M, Kahaleh M. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage: predictors of successful outcome in patients who fail endoscopic retrograde cholangiopancreatography. Surg Endosc. 2016;30:5500-5505.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 63]  [Cited by in F6Publishing: 87]  [Article Influence: 10.9]  [Reference Citation Analysis (0)]
39.  Khashab MA, El Zein M, Ngamruengphong S, Haito Chavez Y, Kumbhari V, Ismail A, Tieu AH, Aguila G, Singh VK, Lennon AM, Canto MI, Kalloo AN. Double endoscopic bypass by using lumen-apposing stents (with videos). Gastrointest Endosc. 2016;83:435-439.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
40.  Kunda R, Pérez-Miranda M, Will U, Ullrich S, Brenke D, Dollhopf M, Meier M, Larghi A. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc. 2016;30:5002-5008.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 119]  [Cited by in F6Publishing: 97]  [Article Influence: 12.1]  [Reference Citation Analysis (0)]
41.  Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33:898-900.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 446]  [Cited by in F6Publishing: 461]  [Article Influence: 20.0]  [Reference Citation Analysis (0)]
42.  Iwamuro M, Kawamoto H, Harada R, Kato H, Hirao K, Mizuno O, Ishida E, Ogawa T, Okada H, Yamamoto K. Combined duodenal stent placement and endoscopic ultrasonography-guided biliary drainage for malignant duodenal obstruction with biliary stricture. Dig Endosc. 2010;22:236-240.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 42]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
43.  Itoi T, Binmoeller KF, Shah J, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Moriyasu F. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75:870-876.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 299]  [Cited by in F6Publishing: 302]  [Article Influence: 25.2]  [Reference Citation Analysis (0)]
44.  Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy. 2012;44:499-503.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 100]  [Cited by in F6Publishing: 118]  [Article Influence: 9.8]  [Reference Citation Analysis (16)]
45.  Itoi T, Itokawa F, Sofuni A, Kurihara T, Ishii K, Tsuji S, Ikeuchi N, Umeda J, Tanaka R, Tonozuka R, Moriyasu F. Endoscopic ultrasound-guided double stenting for biliary and duodenal obstruction. Endosc Ultrasound. 2012;1:36-40.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 3]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
46.  Khashab MA, Kumbhari V, Grimm IS, Ngamruengphong S, Aguila G, El Zein M, Kalloo AN, Baron TH. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc. 2015;82:932-938.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 132]  [Article Influence: 14.7]  [Reference Citation Analysis (3)]
47.  Anderloni A, Buda A, Carrara S, Di Leo M, Fugazza A, Maselli R, Repici A. Single-session double-stent placement in concomitant malignant biliary and duodenal obstruction with a cautery-tipped lumen apposing metal stent. Endoscopy. 2016;48:E321-E322.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 19]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
48.  Khashab MA, Bukhari M, Baron TH, Nieto J, El Zein M, Chen YI, Chavez YH, Ngamruengphong S, Alawad AS, Kumbhari V, Itoi T. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open. 2017;5:E275-E281.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 125]  [Cited by in F6Publishing: 148]  [Article Influence: 21.1]  [Reference Citation Analysis (1)]
49.  Glessing BR, Mallery S, Freeman ML, Newcomb MD, Arain MA. EUS-guided choledochoduodenostomy with a lumen-apposing metal stent before duodenal stent placement for malignant biliary and duodenal obstruction. Gastrointest Endosc. 2015;81:1019-1020.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 18]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
50.  Rai P, Lokesh CR, Goel A, Aggarwal R. Endoscopic ultrasound-guided choledochoduodenostomy using partially-covered self-expandable metal stent in patients with malignant distal biliary obstruction and unsuccessful ERCP. Endosc Int Open. 2018;6:E67-E72.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 20]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
51.  Belletrutti PJ, Gerdes H, Schattner MA. Successful endoscopic ultrasound-guided transduodenal biliary drainage through a pre-existing duodenal stent. JOP. 2010;11:234-236.  [PubMed]  [DOI]  [Cited in This Article: ]