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DOI: 10.1055/a-2008-0376
Endoscopic placement of a self-expandable metal stent for malignant small-intestine obstruction using a digital cholangioscope-guided approach
For malignant gastrointestinal obstruction in inoperable patients, the self-expandable metal stent (SEMS) is a useful nonsurgical palliative treatment to improve patients’ quality of life [1] [2] [3] [4]. The common method of intestinal stent placement is to navigate the guidewire through the narrow segment, which often takes a long time, and sometimes leads to stent placement failure because the guidewire cannot pass through the narrow segment. Here, we describe the successful endoscopic placement of an SEMS using a guidewire after a digital cholangioscope was used to pass through the narrow small intestine.
A 46-year-old man was diagnosed with unresectable primary carcinoma of the horizontal segment of the duodenum with severe intestinal obstruction. After failure of conventional stent placement, we attempted to use a digital cholangioscope to place the guidewire through the narrow segment and guide the SEMS ([Video 1]). First, a digital cholangioscope (eyeMax; Micro-Tech Nanjing, Co., Ltd, Nanjing, China) was inserted through the stenosis and a 0.35-mm guidewire was introduced into the distal small intestine under direct visualization ([Fig. 1]). After retrieval of the digital cholangioscope, the uncovered SEMS was advanced over the wire through the stenosis and gradually deployed under continuous X-ray monitoring ([Fig. 2]). Stent patency was evaluated with iodine contrast agent immediately after placement ([Fig. 3]).
Video 1 Endoscopic placement of a self-expandable metal stent was performed using a digital cholangioscope-guided approach.
Qualität:
The patient was allowed to drink clear liquid on the second day after the operation, and advanced to a low-residue diet on the third day.
For patients with intestinal obstruction, this technique is a fast and effective method for stent placement.
Endoscopy_UCTN_Code_TTT_1AP_2AD
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Publikationsverlauf
Artikel online veröffentlicht:
03. Februar 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
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- 2 Yim H, Jacobson B, Saltzman J. et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 2001; 53: 329-332
- 3 Pinto Pabon I, Diaz L, Ruiz De Adana J. et al. Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol 2001; 24: 147-153
- 4 Lee H, Park JC, Shin SK. et al. Preliminary study of enteroscopy-guided, self-expandable metal stent placement for malignant small bowel obstruction. J Gastroenterol Hepatol 2012; 27: 1181-1186