Endoscopic Treatment of Simultaneous Malignant Biliary and Gastric Outlet Obstruction

  • Brian P. Riff
  • Christopher J. DiMaioEmail author


Patients with advanced GI malignancies, most commonly pancreatic cancer, can develop combined biliary and gastric outlet obstruction. Formerly only treated by surgical gastric and biliary bypass, endoscopy with simultaneous endoscopic and biliary stenting is now the standard first-line approach. Several anatomic variants exist based on the location of the enteric obstruction relative to the Ampulla of Vater that has been shown to predict procedural success. In the event of failed biliary cannulation, alternative approaches including endoscopic ultrasound assisted biliary access and percutaneous approaches should be considered. This chapter covers the workup and therapeutic options to manage combined biliary and enteral obstruction.


Biliary obstruction Gastric outlet obstruction Biliary access Enteral stent Biliary stent Endoscopic ultrasound Simultaneous obstruction EUS biliary access Gastroduodenal obstruction Interventional Radiology 

Supplementary material

Video 8.1

Endoscopic management of combined malignant biliary obstruction and gastric outlet obstruction (MPG 182,006 kb).


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.The Dr. Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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