Photodynamic therapy combined with bimetallic stent in the treatment of gastric cancer with malignant duodenobiliary obstruction: a case report and literature review

Background: Patients with advanced gastric cancer (GC) often and can develop simultaneous or sequential duodenal and biliary obstructions resulting in reduced quality of life and significantly a reduction in the survival time. However, palliative management, insertion of biliary and duodenal metallic stents can relief these obstructions and has become a feasible and safe therapeutic strategic option. However, the operation of bimetallic stents placement is much more difficult and challenging, for instance, cannot prevent tumor progression and reemerge obstructions. Case Description: This report describes and elucidates a patient with GC who has complicated duodenal and biliary obstructions. In this case, the patient was already at an advanced stage when diagnosed, and the patient had a past medical history of cardiac and pulmonary disorders, with the poor general condition and no chance of undergoing any form of laparoscopic surgery. Furthermore, this patient developed severe symptoms of duodenal and biliary obstructions which have resulted in having nutritional disorders and liver dysfunctions post chemotherapeutic treatment regimens. In order to get rid of those obstructions, endoscopic photodynamic therapy (PDT) combined with duodenal metal stent and biliary metal stent was utilized for palliative treatment. In addition, such combined strategies can provide a longer survival time (11 vs. 7.6 months reported before) and improve the quality of life for patients with GC at an advanced stage. Conclusions: PDT combined with bimetallic stents is a safe and excellent therapeutic strategy for advanced GC which has complicated duodenal and biliary obstructions.