Expandable metal stents for treatment of non-esophageal/non-colonic enteral obstruction

Academic Article

Abstract

  • INTRO: Use of metal stents for gastric and small-bowel obstruction is limited. We evaluated the feasibility of expandable metal stents in gastric and small bowel obstruction. METHODS: Eight consecutive pts. with complete gastric or small bowel obstruction were treated with expandable metal stents for palliation (N=7) and pre-operatlvely while medically stabilizing a patient with benign disease as an outpatient (N=1). Pre-and post procedure contrast radiographs were obtained in all. Stents were placed using biliary guidewires and catheters under endoscopic and fluoroscopic guidance. Diet was modified as needed. Success was defined as ability to eat without need for operation, or relief of obstruction for pre-operative decompression. RESULTS: Mean age 66yrs. (Range, 31-90 yrs.). Site/Tumor Stent/Diameter(mm) Intent Outcome Duration Diet Status Gastric CA/ Post resection BI Wallstent/10 Palliate Success 3 mos. Liquid Dead-patent Gastric CA/Antrum Ultraflex/18 Palliate Success 3 mos. Solid Dead-patent Duodenum-Pancreatic CA Wallstent/10 Palliate Success-Ingrowth 3 mos. Solid-Liquid Alive-patent Restented Duodenum-Met. Breast CA Wallstent/10 Palliate Success 2 wks. Liquid Dead-patent Duodenum-Met. Colon CA Wallstent/14 Palliate Success 3 wks. Solid Dead-patent Duodenum-Met. SCCA Anus Wallstent/10 Palliate Success-Ingrowth 2 mos. Solid Dead-occluded Jejunum-met. Colon CA. Wallstent/10 Palliate Success 3 days Solid Dead-pneumonia Ileo-rectal - benign Wallstent/ 22 Pre-op Success 1 mo. Solid Alive Five patients died of malignant disease and one died from co-morbid disease; there were no procedure-related deaths. Re-obstruction due to tumor ingrowth occurred at 2 and 2.5 months respectively, with successful restenting in one. Concomitant obstructing large bowel lesions seen in 1. CONCLUSIONS: 1) Successful gastric and small bowel stenting is feasible using available endoprostheses 2) Tumor ingrowth/overgrowth remains a problem with small diameter uncovered stents 3) Radiographic evaluation is needed to identify other sites of lumenal obstruction 4) Gastric and small bowel stenting is a viable alternative to surgical therapy for palliation of malignant gastric and small bowel obstruction given the availability and potential cost-effectiveness in terminally-ill patients.
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    Author List

  • Baron TH; Morgan DE
  • Start Page

  • 348
  • Volume

  • 43
  • Issue

  • 4