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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

Full deployment of stent-in-stent with perfect distal positioning is confirmed.
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Figure 7: Full deployment of stent-in-stent with perfect distal positioning is confirmed.

Mentions: A new SEMS (90-mm length, 10-mm diameter; Boston Scientific, Natick, MA, USA) was inserted across the previous two SEMS using the herein described balloon overtube technique using the following six steps. First, the enteroscope was kept across the stenosis in the upper jejunum (Fig. 2). Second, a Jagwire guidewire (Boston Scientific) was inserted in the jejunum (Figs. 2, 3). Third, the scope was removed under fluoroscopic guidance and the wire was left in place (Fig. 4). Fourth, the overtube, which was looped and kinked in the J-shaped stomach, was straightened (Fig. 5). A trick was used to straighten the overtube without losing its position; that is, the balloon of the overtube was inflated distally to the stent. This maneuver allowed the overtube tip to get hooked to the distal part of the overtube while being pulled (i.e., straightened). The overtube straightening was essential to advance the stent through the wire inside the overtube and across the previous stents (Fig. 6; step 5). Sixth, the distal part of the stent was deployed under fluoroscopic guidance while the now deflated overtube was carefully brought back into the stomach through the old stent, thus permitting the new stent to deploy distal to the old stent and the overtube tip across the obstruction (Figs. 6, 7). The patient is asymptomatic 3 months after the procedure.


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)

Full deployment of stent-in-stent with perfect distal positioning is confirmed.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Full deployment of stent-in-stent with perfect distal positioning is confirmed.
Mentions: A new SEMS (90-mm length, 10-mm diameter; Boston Scientific, Natick, MA, USA) was inserted across the previous two SEMS using the herein described balloon overtube technique using the following six steps. First, the enteroscope was kept across the stenosis in the upper jejunum (Fig. 2). Second, a Jagwire guidewire (Boston Scientific) was inserted in the jejunum (Figs. 2, 3). Third, the scope was removed under fluoroscopic guidance and the wire was left in place (Fig. 4). Fourth, the overtube, which was looped and kinked in the J-shaped stomach, was straightened (Fig. 5). A trick was used to straighten the overtube without losing its position; that is, the balloon of the overtube was inflated distally to the stent. This maneuver allowed the overtube tip to get hooked to the distal part of the overtube while being pulled (i.e., straightened). The overtube straightening was essential to advance the stent through the wire inside the overtube and across the previous stents (Fig. 6; step 5). Sixth, the distal part of the stent was deployed under fluoroscopic guidance while the now deflated overtube was carefully brought back into the stomach through the old stent, thus permitting the new stent to deploy distal to the old stent and the overtube tip across the obstruction (Figs. 6, 7). The patient is asymptomatic 3 months after the procedure.

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