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Preliminary study of enteroscopy-guided, self-expandable metal stent placement for malignant small bowel obstruction

 Hyuk Lee  ;  Jun Chul Park  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
 Journal of Gastroenterology and Hepatology, Vol.27(7) : 1181-1186, 2012 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Aged ; Double-Balloon Enteroscopy/adverse effects ; Double-Balloon Enteroscopy/methods* ; Duodenal Obstruction/etiology ; Duodenal Obstruction/surgery ; Feasibility Studies ; Female ; Gastric Outlet Obstruction/etiology ; Gastric Outlet Obstruction/surgery ; Humans ; Intestinal Neoplasms/complications* ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery* ; Jejunal Diseases/etiology ; Jejunal Diseases/surgery ; Kaplan-Meier Estimate ; Male ; Metals ; Middle Aged ; Palliative Care/methods ; Stents*/adverse effects ; Stomach Neoplasms/complications ; Treatment Outcome
double balloon enteroscopy ; gastrointestinal neoplasm ; intestinal obstruction ; stent.
BACKGROUND AND AIMS: Technical limitations of conventional endoscopes and delivery systems frequently hamper palliative endoscopic placement of self-expandable metal stents for malignant small bowel obstruction. This study examined feasibility of the double balloon enteroscope-guided withdrawal-reinsertion method as a rescue procedure in patients with failed palliative stent placement for malignant small bowel obstruction. METHODS: We enrolled 19 consecutive patients with small bowel obstruction due to metastatic gastric (n = 15) or colorectal cancer (n = 2), or primary small bowel carcinoma (n = 2), in whom previous attempts to place self-expandable metal stents using conventional endoscopy had failed. Ten patients had undergone previous gastric surgery. After passing a guide-wire using an enteroscope with or without the double-balloon method, the enteroscope was withdrawn. A conventional endoscope was re-inserted along the guide-wire, and through-the-scope self-expandable metal stent placement was performed. RESULTS: Obstruction sites were efferent jejunal loop, proximal jejunum, and third duodenal portion. Technical success was achieved with 94.7% (18/19) of stents, and clinical success occurred with 84.2% (16/19) of patients. The gastric outlet obstruction score (pre-procedure: 0.68 ± 0.58) increased by one week (2.05 ± 0.52, P < 0.001). Stent migration and restenosis occurred in two (10.5%) and four (21.1%) of 19 stents, respectively. Median stent patency duration was 67 days and median survival was 93 days; these did not differ significantly by palliative chemotherapy (P = 0.76 and 0.67, respectively). CONCLUSIONS: The double-balloon enteroscopy-guided method followed by conventional endoscopic self-expandable metal stent delivery was effective for rescue palliation of malignant small bowel obstruction.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
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