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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy pp 1–15Cite as

Treatment of Concomitant Malignant Biliary Stricture and Gastric Outlet Obstruction

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Abstract

The obstruction of gastric outlet or duodenum is a possible occurrence in periampullary malignancies. The options for palliation in these cases are surgical double bypass, endoscopic stenting, and percutaneous biliary drainage in combination with endoscopic enteral stent placement.

Historically, palliative surgery, hepaticojejunostomy, and gastrojejunostomy were carried out, but the current standard treatment is combined transpapillary stent and duodenal stent placement. Although a high technical success rate is reported, the procedure can be technically difficult, and duodenobiliary reflux with subsequent cholangitis is possible after double stenting.

In terms of quality of life, morbidity, and cost of the procedure, endoscopic palliation is superior to surgical bypass. In cases with failure of ERCP, percutaneous or EUS-assisted drainage procedures are today effective minimally invasive alternatives.

In this chapter, we will deal with the purely endoscopic approach (without the help of the EUS) when the stenosis is above or at the level of the papilla, that is, when the obstacle is between the pylorus and the duodenal knee or the second duodenal portion.

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Author information

Authors and Affiliations

  1. Gastroenterology and Digestive Endoscopy Unit, University Hospital, Modena, Italy

    Rita Conigliaro, Salvatore Russo & Giuseppe Grande

Authors
  1. Rita Conigliaro
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  2. Salvatore Russo
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  3. Giuseppe Grande
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Editor information

Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Conigliaro, R., Russo, S., Grande, G. (2020). Treatment of Concomitant Malignant Biliary Stricture and Gastric Outlet Obstruction. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_83-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_83-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-29964-4

  • Online ISBN: 978-3-030-29964-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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