Biliary

Gastric outlet obstruction commonly manifests clinically in patients with both benign and malignant disease of the distal stomach, duodenum or pancreas

The most common causes of malignant gastro-duodenal obstruction are gastric and pancreatic carcinoma. In patients with pancreatic cancer, curative resection is not possible in nearly 85% of cases and 15 to 20% may develop duodenal obstruction (42-44). The standard therapy for many years was surgical palliation but is associated with a high complication rate due to the poor overall condition and advanced malnutrition frequently seen in these patients (41;45).

Gastroduodenal stent placement is a minimally invasive approach that may provide better palliation of symptoms than surgery and offers several potential advantages: it may be performed as an out-patient procedure, allows more rapid gastric emptying, is associated with minimal complications and is both cost effective and may improve quality of life (41). Technical success rates are similar whether using fluoroscopy alone or a combination of endoscopy and fluoroscopy (46;47). Rates of technical success vary from 94 to 100% (43;44) and recent advances in the design of metallic stents with longer and more flexible delivery systems have facilitated this process (48).