scholarly journals Delayed Migration of a WallFlex Enteral Stent Resulting in Jejunal Perforation

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Phillip S. Ge ◽  
Rabindra R. Watson ◽  
David C. Chen ◽  
V. Raman Muthusamy
Keyword(s):  
Unusual Case ◽  
Acute Abdominal Pain ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Stent Patency ◽  
Enteral Stent ◽  
Gastrointestinal Obstruction ◽  
Uncovered Stents ◽  
Enteral Stents ◽  
Malignant Gastrointestinal Obstruction

Enteral stents are increasingly utilized to palliate malignant gastrointestinal obstruction; however, they can be associated with significant complications. We describe an unusual case of a 67-year-old male with gastric adenocarcinoma who underwent placement of a WallFlex metallic enteral stent to relieve a malignant gastric outlet obstruction. Four months later, while actively undergoing chemotherapy, he developed acute abdominal pain and was found to have delayed stent migration and jejunal perforation. He required emergent surgical resection of the perforated segment of jejunum. Delayed migration of the WallFlex enteral stent with subsequent visceral perforation has yet to be reported in the literature. Chemotherapy after stent placement has been associated with an increase in maintenance of stent patency; however, shrinkage of the local tumor by chemoradiation may increase the risk of stent migration. Care should be taken in placing enteral stents in patients undergoing continued treatment of their malignancy, as delayed migration of even uncovered stents may occur.

scholarly journals Covered Metal Stent after Dysfunction of Uncovered Stents for Palliation of Gastrointestinal Malignant Obstruction

2020 ◽  
Vol 27 (6) ◽  
pp. 383-390
Author(s):  
Marta Patita ◽  
Rui Castro ◽  
Diogo Libânio ◽  
Rui Pedro Bastos ◽  
Rui Silva ◽  
...  
Keyword(s):  
Adverse Events ◽  
Palliative Treatment ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Metal Stents ◽  
Consecutive Series ◽  
Stent Patency ◽  
Gastrointestinal Obstruction ◽  
Tertiary Center ◽  
Malignant Gastrointestinal Obstruction

<b><i>Background:</i></b> Self-expanding metal stents (SEMS) have been used for the palliative treatment of malignant gastrointestinal tract obstruction. However, restenosis or incomplete expansion of a first stent is a frequent complication, and the effectiveness of reintervention with placement of a second stent is still controversial. <b><i>Objective:</i></b> To evaluate the clinical outcomes of covered SEMS (cSEMS) placement after dysfunction of uncovered SEMS (uSEMS) by the stent-in-stent technique. <b><i>Patients and Methods:</i></b> We retrospectively studied a consecutive series of patients receiving palliative treatment for malignant gastrointestinal obstruction with cSEMS placement after uSEMS dysfunction in a tertiary center from January 2013 to August 2018. Technical and clinical success, time of patency, and adverse events were analyzed. <b><i>Results:</i></b> Twelve patients were included; their mean age was 60 ± 9 years. Eleven patients had gastric outlet obstruction, and 1 patient had compression of the transverse colon due to gastric neoplasia. In 5 cases, there was absence of early clinical success with uSEMS and stent dysfunction in 7 cases (median patency time: 81 days). There was 100% technical success and 91.7% clinical success after cSEMS placement. There were no adverse events nor need for reintervention. The median patency time after placement of both stents was 163 days (vs. 71 days with the initial stent). <b><i>Conclusion:</i></b> cSEMS placement after uSEMS dysfunction is technically feasible and a clinically effective treatment for patients with recurrent malignant gastrointestinal obstruction, with good stent patency in the medium/long term. This approach seems to be safe and without increase in adverse effects.

scholarly journals Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

Gut ◽  
2020 ◽  
pp. gutjnl-2020-320775
Author(s):  
Kentaro Yamao ◽  
Masayuki Kitano ◽  
Yasutaka Chiba ◽  
Takeshi Ogura ◽  
Takaaki Eguchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gastric Outlet Obstruction ◽  
Patient Survival ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Metal Stents ◽  
Covered Stents ◽  
Malignant Gastric Outlet Obstruction ◽  
Uncovered Stents ◽  
Endoscopic Placement

ObjectiveStenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results.DesignIn a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours.ResultsOverall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01).ConclusionsDue to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

Anchoring with Endoscopic Clips for Prevention of Enteral Stent Migration in Patients with Malignant Gastric Outlet Obstruction

2009 ◽  
Vol 69 (5) ◽  
pp. AB262-AB263
Author(s):  
Dae Hwan Kang ◽  
Cheol Woong Choi ◽  
Hyung Wook Kim ◽  
Yong Wuk Kim ◽  
Min Dae Kim ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Malignant Gastric Outlet Obstruction ◽  
Enteral Stent ◽  
Endoscopic Clips

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

2020 ◽  
Vol 04 (03) ◽  
pp. 311-322
Author(s):  
Robert J. Litwin ◽  
Johanna L. Chan ◽  
Steven Y. Huang
Keyword(s):  
Clinical Presentation ◽  
Practice Patterns ◽  
Patient Care Team ◽  
Therapeutic Interventions ◽  
Collaborative Approach ◽  
Malignant Bowel Obstruction ◽  
Advanced Malignancy ◽  
Gastrointestinal Obstruction ◽  
Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

Endoscopy ◽  
2021 ◽  
Author(s):  
Amanda Marino ◽  
Ali Bessissow ◽  
Corey Miller ◽  
David Valenti ◽  
Louis Boucher ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Outlet Obstruction ◽  
Stent Migration ◽  
Stent Insertion ◽  
Ultrasound Guided ◽  
Double Balloon ◽  
Low Residue Diet ◽  
The Mean

Abstract Introduction We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. Results 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. Conclusion M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

scholarly journals Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis: enteral stenting versus surgery

2020 ◽  
Vol 08 (10) ◽  
pp. E1487-E1494
Author(s):  
Veeravich Jaruvongvanich ◽  
FNU Chesta ◽  
Anushka Baruah ◽  
Meher Oberoi ◽  
Daniel Adamo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Peritoneal Carcinomatosis ◽  
Large Scale ◽  
Clinical Success ◽  
Eastern Cooperative Oncology Group ◽  
Length Of Hospital Stay ◽  
Palliative Surgery ◽  
Gastrointestinal Obstruction ◽  
Malignant Gastrointestinal Obstruction

Abstract Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.

Minimally Invasive Interventional Management of Gastric Outlet Obstructions

2018 ◽  
Vol 02 (01) ◽  
pp. 025-032
Author(s):  
Wei-Zhong Zhou ◽  
Zheng-Qiang Yang
Keyword(s):  
Stent Placement ◽  
Balloon Dilatation ◽  
Outlet Obstruction ◽  
Covered Stent ◽  
Clinical Consequence ◽  
Endoscopic Stenting ◽  
Stent Patency ◽  
Ulcer Disease ◽  
Recommended Treatment ◽  
Uncovered Stent

AbstractGastric outlet obstruction (GOO) is a clinical consequence of any disease that produces intrinsic or extrinsic obstruction of the pyloric channel or duodenum. The most common symptoms of GOO include nausea, vomiting, abdominal pain, and weight loss. Traditionally, surgery is regarded as the standard treatment modality. However, with the development of mini-invasive technologies, fluoroscopic or endoscopic stenting and balloon dilatation have become the mainstream of the therapies. The initial recommended treatment for malignant GOO is self-expanding metal stent placement. The stent can be classified into covered and uncovered stent according to whether it is coated with a membrane. Covered stent seems to have longer stent patency, while uncovered stent has the advantage of a lower migration rate. Regarding the etiology of benign GOO, peptic ulcer disease and corrosive injury are the two main reasons. Balloon dilatation is a simple and convenient way to treat the benign GOO. Stent placement has recently been reported for the treatment of benign GOO; however, it needs further more studies to verify its effect. This article presents a concise review of current fluoroscopic or endoscopic stenting practice for malignant GOO and balloon dilatation or stenting for benign GOO.

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