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Article: Self-expandable metal stent placement for malignant duodenal obstruction distal to the bulb

TitleSelf-expandable metal stent placement for malignant duodenal obstruction distal to the bulb
Authors
KeywordsDuodenal obstruction
Endoscopy
Enteral feeding
Palliative treatment
Stents
Issue Date2015
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.eurojgh.com
Citation
European Journal of Gastroenterology and Hepatology, 2015, v. 27 n. 12, p. 1466-1472 How to Cite?
AbstractObjective: Self-expandable metal stents (SEMS) are widely used for the palliative management of malignant proximal gastroduodenal obstruction because of its low morbidity and mortality rates compared with surgical bypass. However, stent placement for duodenal obstruction beyond the first part of the duodenum is considered technically difficult and is not routinely performed. We report our experience with SEMS placement for these patients. Methods: Between 2006 and 2015, 51 patients with unresectable or metastatic malignancy underwent SEMS placements under combined endoscopic and fluoroscopic guidance. Eighteen patients had intestinal obstruction distal to the duodenal bulb. Their demographics, technical and clinical outcomes, periprocedural morbidity and mortality, length of hospital stay, further interventions and overall survival were analysed. Results: Out of the 18 cases, nine cases of intestinal obstruction were due to primary malignancy of the pancreas, three due to gastric malignancy, three from other locoregional cancers and three were the result of metastases. In 12 patients, the obstruction involved the second part (D2), in four the third part (D3) and in two the fourth part (D4) of the duodenum. A front-facing therapeutic gastroscope was used to visualize the duodenum before the stricture was crossed under direct vision and fluoroscopic guidance, with a catheter and guidewire, and a through-the-scope SEMS deployed using an ‘over-the-wire’ technique. Technical success rate was 89%. The mean gastric outlet obstruction scores improved from 0.63 to 2.57 (P<0.0001). Four patients died within 30 days of the procedure, although none of the deaths were procedure related. The median length of postprocedural hospital stay was 4 days and the median overall survival was 58 days.
Persistent Identifierhttp://hdl.handle.net/10722/222787
ISSN
2015 Impact Factor: 2.093
2015 SCImago Journal Rankings: 0.867
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChiu, WHK-
dc.contributor.authorRazack, A-
dc.contributor.authorMaraveyas, A-
dc.date.accessioned2016-01-29T02:53:38Z-
dc.date.available2016-01-29T02:53:38Z-
dc.date.issued2015-
dc.identifier.citationEuropean Journal of Gastroenterology and Hepatology, 2015, v. 27 n. 12, p. 1466-1472-
dc.identifier.issn0954-691X-
dc.identifier.urihttp://hdl.handle.net/10722/222787-
dc.description.abstractObjective: Self-expandable metal stents (SEMS) are widely used for the palliative management of malignant proximal gastroduodenal obstruction because of its low morbidity and mortality rates compared with surgical bypass. However, stent placement for duodenal obstruction beyond the first part of the duodenum is considered technically difficult and is not routinely performed. We report our experience with SEMS placement for these patients. Methods: Between 2006 and 2015, 51 patients with unresectable or metastatic malignancy underwent SEMS placements under combined endoscopic and fluoroscopic guidance. Eighteen patients had intestinal obstruction distal to the duodenal bulb. Their demographics, technical and clinical outcomes, periprocedural morbidity and mortality, length of hospital stay, further interventions and overall survival were analysed. Results: Out of the 18 cases, nine cases of intestinal obstruction were due to primary malignancy of the pancreas, three due to gastric malignancy, three from other locoregional cancers and three were the result of metastases. In 12 patients, the obstruction involved the second part (D2), in four the third part (D3) and in two the fourth part (D4) of the duodenum. A front-facing therapeutic gastroscope was used to visualize the duodenum before the stricture was crossed under direct vision and fluoroscopic guidance, with a catheter and guidewire, and a through-the-scope SEMS deployed using an ‘over-the-wire’ technique. Technical success rate was 89%. The mean gastric outlet obstruction scores improved from 0.63 to 2.57 (P<0.0001). Four patients died within 30 days of the procedure, although none of the deaths were procedure related. The median length of postprocedural hospital stay was 4 days and the median overall survival was 58 days.-
dc.languageeng-
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.eurojgh.com-
dc.relation.ispartofEuropean Journal of Gastroenterology and Hepatology-
dc.rightsThis is a non-final version of an article published in final form in (European Journal of Gastroenterology and Hepatology, 2015, v. 27 n. 12, p. 1466-1472)-
dc.subjectDuodenal obstruction-
dc.subjectEndoscopy-
dc.subjectEnteral feeding-
dc.subjectPalliative treatment-
dc.subjectStents-
dc.titleSelf-expandable metal stent placement for malignant duodenal obstruction distal to the bulb-
dc.typeArticle-
dc.identifier.emailChiu, WHK: kwhchiu@hku.hk-
dc.identifier.authorityChiu, WHK=rp02074-
dc.identifier.doi10.1097/MEG.0000000000000479-
dc.identifier.pmid26426837-
dc.identifier.scopuseid_2-s2.0-84947020106-
dc.identifier.hkuros264742-
dc.identifier.volume27-
dc.identifier.issue12-
dc.identifier.spage1466-
dc.identifier.epage1472-
dc.identifier.isiWOS:000364330100020-
dc.publisher.placeUnited States-

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