Expandable metallic prostheses for malignant obstructions of gastric outlet and proximal small bowel☆,☆☆,★
Section snippets
Methods and Materials
We reviewed the records of eight patients with malignant strictures of the gastric outlet and proximal small bowel treated with expandable prostheses between 1991 to 1997. Data collected included patient demographics, diagnosis, indication for stent placement (with type and location of stent), and overall outcome. Outcome criteria included survival data, need for reintervention, and the ability to take oral nutrition.
Prostheses placed included the Endocoil (Instent Inc., Eden Prairie, Minn.),
Results
Patients were divided into those who had undergone previous surgery for obstruction and those patients with nonoperative, widespread disease. All presented with signs of gastric outlet and proximal small bowel obstruction. A subset of these patients were previously reported in a series that included colorectal stents.36
Five patients who had previously undergone surgical procedures developed strictures related to local recurrence at or near the surgical anastomoses (Billroth II, Whipple,
Discussion
We used a variety of expandable metallic prostheses to palliate patients with malignant gastric outlet and proximal small bowel obstruction who were at significant risk for initial or follow-up surgical decompression or who would benefit nutritionally before surgery. All stent insertions were technically successful and clinical improvement, defined as increased oral intake, was noted in seven of eight (87.5%) patients. Moreover, in the five patients who have died to date, mean survival was
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2015, Diagnostic and Interventional ImagingCitation Excerpt :Delayed complications include migration, perforation, obstruction, duodenal fistula or stent fracture, and can be treated with a new stent. Migration rate for covered stent is about 25% [76], and obstruction of non-covered stent is about 15% [87]. Risk factor for early uncovered stent obstruction is stenosis of a gastrojejunal or a gastroduodenal anastomosis [88].
Antral localization worsens the efficacy of enteral stents in malignant digestive tumors
2011, Gastroenterologia y HepatologiaCitation Excerpt :These same reasons could also explain the bad results of surgical gastrojejunostomy often reported in patients with large antral tumors causing gastric outlet obstruction.9 In most published studies, duodenal stents are placed combining endoscopic and radiologic control.18–24 The probable reason for this is the belief that, in the duodenum, morphologic and topographic characteristics of the stenotic lesion are better determined with double (endoscopic and radiologic) control, while radiology offers a better image of stent positioning and expansion in the suprastenothic segment, eventually allowing, if placement and/or expansion are not satisfactory, the immediate replacement of the stent.
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From the Department of Radiology, Section of Gastroenterology, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
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Reprint requests: Adam W. Nevitt, MD, Department of Radiology, virginia Mason Medical Center, 1100 Ninth Ave., PO Box 900 (C5-XR), Seattle, WA 98111.
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