CLINICAL INVESTIGATION Fluoroscopic Gastroduodenal Stent Placement in 55 Patients with Endoscopic Stent Placement Failure Nader Bekheet 1,3 • Min Tae Kim 1,4 • Jung-Hoon Park 1,2 • Kun Yung Kim 1 • Jiaywei Tsauo 1 • Wang Zhe 1 • Young Je Lim 1 • Ho-Young Song 1 Received: 7 December 2017 / Accepted: 6 March 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018 Abstract Purpose To evaluate the technical feasibility and clinical effectiveness of fluoroscopic self-expandable metal stent (SEMS) placement in malignant gastroduodenal obstruc- tions after failed endoscopic SEMS placement. Materials and Methods Between September 2010 and July 2017, 874 patients underwent endoscopic SEMS placement for dysphagia caused by malignant gastroduodenal obstructions. Endoscopic SEMS placement failed in 55 of 874 patients (6.3%). These patients were referred for flu- oroscopic SEMS placement. In case of failed fluoroscopic SEMS placement, combined endoscopic and fluoroscopic SEMS placement was attempted at the same setting. Results Fluoroscopic SEMS placement was technically successful in 40 of 55 patients (72.7%). Combined endo- scopic and fluoroscopic SEMS placement was technically successful in 6 of 15 patients with fluoroscopic SEMS placement failure. Failures in the nine patients were due to complete obstruction (n = 5) and acute angulation at the stricture site (n = 4). The overall technical success rate was 83.6% (46/55). Clinical success was achieved in 95.6% of patients (44/46). Complications occurred in 7 of 46 patients (15.2%), including tumor overgrowth (n = 3), SEMS migration (n = 3), and bleeding (n = 1). The median SEMS patency and patient survival periods were 515 (95% confidence interval (CI), 266.6–761.5) and 83 (95% CI 60.6–105.4) days, respectively. Conclusions Fluoroscopic SEMS placement is technically feasible and clinically effective in cases of endoscopic SEMS placement failure. A combined endoscopic and fluoroscopic approach increases the technical success rate after failure of the endoscopic or fluoroscopic approach. Level of Evidence Level IV. Keywords Gastric outlet obstruction Á Endoscopy Á Fluoroscopy Á Self-expandable metal stents Abbreviations CI Confidence interval SDS Stent delivery system SEMS Self-expandable metal stent Introduction Obstruction of the stomach or duodenum by an unre- sectable malignancy leads to nausea, vomiting, and cachexia, causing a progressive deterioration in the general condition of the patient [1, 2]. The primary aim in these patients is to relieve the obstruction and allow enteral feeding, thus improving the patients’ weight and quality of Nader Bekheet and Min Tae Kim have contributed equally to this work. & Ho-Young Song hysong@amc.seoul.kr 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea 2 Department of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea 3 Gastrointestinal Endoscopy and Liver Unit, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt 4 Department of Radiologic Technology, Cheju Halla University, Jeju, Republic of Korea 123 Cardiovasc Intervent Radiol https://doi.org/10.1007/s00270-018-1933-0