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Double EUS-bypass versus conventional endoscopic strategies for concurrent malignant gastric outlet and biliary obstruction

Objectives Advanced malignancies frequently cause concurrent malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). Conventional endoscopic approaches would be duodenal stenting combined with endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliar...

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Auteurs principaux: Shen, Shanshan (Auteur) , Nie, Shuang (Auteur) , Shi, Jiaqi (Auteur) , Shi, Zhao (Auteur) , Liu, Kun (Auteur) , Jiang, Yihang (Auteur) , Zhang, Song (Auteur) , Zhang, Feng (Auteur) , Ni, Muhan (Auteur) , Tang, Dehua (Auteur) , Li, Hongzhen (Auteur) , Yu, Yuanyuan (Auteur) , Yang, Zhuo (Auteur) , Gu, Jiangning (Auteur) , Kong, Bo (Auteur) , Friess, Helmut (Auteur) , Pan, Yanglin (Auteur) , Tang, Bei (Auteur) , Li, Wenting (Auteur) , Cai, Wei (Auteur) , Li, Wen (Auteur) , Lv, Ying (Auteur) , Luo, Hui (Auteur) , Wang, Lei (Auteur)
Format: Article (Journal)
Langue:anglais
Publié: 27 May 2026
In: Journal of gastroenterology and hepatology
Year: 2026, Volume: 41, Numéro: 7, Pages: 2115-2123
ISSN:1440-1746
DOI:10.1111/jgh.70407
Accès en ligne:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/jgh.70407
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/jgh.70407
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Notes sur l'auteur:Shanshan Shen, Shuang Nie, Jiaqi Shi, Zhao Shi, Kun Liu, Yihang Jiang, Song Zhang, Feng Zhang, Muhan Ni, Dehua Tang, Hongzhen Li, Yuanyuan Yu, Zhuo Yang, Jiangning Gu, Bo Kong, Helmut Friess, Yanglin Pan, Bei Tang, Wenting Li, Wei Cai, Wen Li, Ying Lv, Hui Luo, Lei Wang
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Résumé:Objectives Advanced malignancies frequently cause concurrent malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). Conventional endoscopic approaches would be duodenal stenting combined with endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD), with limited long-term efficacy. Novel therapeutic endoscopic ultrasound (EUS), known as double EUS-bypass, may offer improved outcomes. This study aimed to compare the efficacy and safety of two approaches for managing concurrent MBO and GOO. Methods In this retrospective cohort study, 106 patients with concurrent MBO and GOO were included between 2011 and 2025. Among them, 44 underwent double EUS-bypass, while 62 received conventional endoscopic approaches. Clinical success rate, technical success, adverse events, re-intervention rate, and long-term patency were compared. Results Technical success was achieved in 93.2% of the EUS group and 100% of the traditional group (p = 0.136). The clinical success rate was significantly higher in the EUS group (59.1% vs. 37.1%, p = 0.041), particularly in postoperative improvement on GOO (p = 0.007). Recurrence rates of MBO and GOO were significantly lower in the EUS group (p = 0.078 and p = 0.010, respectively). Notably, the re-intervention rate was markedly reduced in the EUS group (9.1% vs. 46.8%, p < 0.001). Adverse event rates, procedure duration, and hospitalization length were comparable between groups. Conclusions Double EUS-bypass offers superior clinical outcomes and reduces the need for re-intervention in patients with concurrent malignant GOO and MBO compared to conventional endoscopic approaches.
Description:Gesehen am 24.09.2026
Description matérielle:Online Resource
ISSN:1440-1746
DOI:10.1111/jgh.70407

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