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Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique.

Popa D, Ramesh J, Peter S, Wilcox CM, Mönkemüller K - Clin Endosc (2014)

Bottom Line: Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction.However, endoscopic delivery and placement to the small bowel is more challenging and difficult.This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Birmingham, AL, USA.

ABSTRACT
Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

No MeSH data available.


Related in: MedlinePlus

The previously placed self-expanding metal stent was obstructed owing to tissue ingrowth and the small bowel kinking distally to the stent.
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Figure 1: The previously placed self-expanding metal stent was obstructed owing to tissue ingrowth and the small bowel kinking distally to the stent.

Mentions: An 80-year-old woman who underwent a pylorus-preserving Whipple procedure 6 years previous for pancreatic head cancer and recurrent disease with duodenal obstruction of the previous placement of two palliative SEMSs was referred to our institution for bowel obstruction distal to the ligament of Treitz. The stents had been placed 2 years and 11 months prior, respectively. Placement of a third stent using esophagogastroduodenoscopy and standard and pediatric colonoscopes had failed. We used a double-balloon enteroscope (DBE) to perform the procedure. The previously placed SEMS was obstructed owing to ingrowth with tissue and the small bowel kinking distally to the stent (Fig. 1). A large amount of impacted food was removed by flushing and suctioning. Using endoscopic and fluoroscopic visualization, the enteroscope was carefully advanced into the jejunum after dilating the stricture. After the scope was advanced, the overtube was gently pushed across the dilation. Deep enteroscopy was then performed, and no other obstructions were found in the afferent or efferent limbs. The Roux-en-Y anastomosis was located approximately 50 cm distal to the pylorus.


Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique.

Popa D, Ramesh J, Peter S, Wilcox CM, Mönkemüller K - Clin Endosc (2014)

The previously placed self-expanding metal stent was obstructed owing to tissue ingrowth and the small bowel kinking distally to the stent.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928482&req=5

Figure 1: The previously placed self-expanding metal stent was obstructed owing to tissue ingrowth and the small bowel kinking distally to the stent.
Mentions: An 80-year-old woman who underwent a pylorus-preserving Whipple procedure 6 years previous for pancreatic head cancer and recurrent disease with duodenal obstruction of the previous placement of two palliative SEMSs was referred to our institution for bowel obstruction distal to the ligament of Treitz. The stents had been placed 2 years and 11 months prior, respectively. Placement of a third stent using esophagogastroduodenoscopy and standard and pediatric colonoscopes had failed. We used a double-balloon enteroscope (DBE) to perform the procedure. The previously placed SEMS was obstructed owing to ingrowth with tissue and the small bowel kinking distally to the stent (Fig. 1). A large amount of impacted food was removed by flushing and suctioning. Using endoscopic and fluoroscopic visualization, the enteroscope was carefully advanced into the jejunum after dilating the stricture. After the scope was advanced, the overtube was gently pushed across the dilation. Deep enteroscopy was then performed, and no other obstructions were found in the afferent or efferent limbs. The Roux-en-Y anastomosis was located approximately 50 cm distal to the pylorus.

Bottom Line: Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction.However, endoscopic delivery and placement to the small bowel is more challenging and difficult.This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, Birmingham, AL, USA.

ABSTRACT
Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

No MeSH data available.


Related in: MedlinePlus