{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:44:42Z","timestamp":1788993882244,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Combined biliary obstruction and gastric outlet obstruction (GOO) represent a challenging clinical scenario despite developments in therapeutic endoscopic ultrasonography (EUS) as GOO might impair EUS\u2010guided biliary drainage. Little is known about the effectiveness of different therapeutic combinations used to treat double obstruction, especially regarding stent patency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All consecutive patients with double obstruction treated between 2016 and 2021 in three tertiary academic centres were eligible for inclusion. Five combinations involving enteral stenting (ES), EUS\u2010guided gastroenterostomy (EUS\u2010GE), hepaticogastrostomy (EUS\u2010HGS), choledochoduodenostomy (EUS\u2010CDS), and transpapillary biliary stenting (TPS) were evaluated for dysfunction during follow\u2010up, either as proportions or dysfunction\u2010free survival (DFS) using Kaplan\u2013Meier estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010three patients were included (male 46%; age 67 [interquartile range 60\u201376] years; pancreatic cancer 73%, metastatic 57%), resulting in 103 procedure combinations. Different combinations showed significantly different overall dysfunction rates (<jats:italic>p<\/jats:italic> = 0.009), ranging from the null rate of EUS\u2010GE+HG to the 18% rate of EUS\u2010GE+TPS, 31% of EUS\u2010GE+EUS\u2010CD, 53% of ES+TPS and 83% of ES+EUS\u2010CDS. Sub\u2010analyses restricted to biliary dysfunction confirmed these trends. A multivariate Cox proportional\u2010hazards regression of DFS, a stenosis distal to the papilla (HR 3.2 [1.5\u20136.9]) and ES+EUS\u2010CDS (HR 5.6 [2\u201315.7]) independently predicted dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite a lack of statistical power per combination, this study introduces new associations beyond the increased risk of GOO recurrence with ES versus EUS\u2010GE. EUS\u2010CDS showed reduced effectiveness and frequent dysfunction in the context of GOO, especially when combined with ES. EUS\u2010GE+HGS or EUS\u2010GE+TPS in this setting might result in superior patency. These results suggest that a prospective evaluation of the optimal endoscopic approach to malignant double obstruction is needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/deo2.132","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T12:30:34Z","timestamp":1655209834000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-1761","authenticated-orcid":false,"given":"Giuseppe","family":"Vanella","sequence":"first","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre IRCCS San Raffaele Scientific Institute and University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2039-5022","authenticated-orcid":false,"given":"Michiel","family":"Bronswijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven  Leuven Belgium"},{"name":"Department of Gastroenterology and Hepatology Imelda General Hospital  Bonheiden Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy LJ","family":"van Wanrooij","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC, Vrije Universiteit, Amsterdam Gastroenterology Endocrinology and Metabolism  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Dell'Anna","sequence":"additional","affiliation":[{"name":"Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre IRCCS San Raffaele Scientific Institute and University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Laleman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"van Malenstein","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Gasthuisberg University of Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier P","family":"Voermans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism  Amsterdam the 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