胃流出道恶性梗阻的金属支架置入治疗

目的探讨金属支架治疗胃流出道恶性梗阻的操作技术及其临床疗效。方法12例胃流出道恶性梗阻患者中,胃恶性淋巴瘤1例,胰体癌术后浸润胃肠吻合口1例,胃窦癌6例,胰头癌4例。在X线电视监视下经口置入国产镍钛合金网状裸支架。除4例体质虚弱外,余8例均接受动脉插管化疗或全身化疗。结果12例患者共放置金属支架14枚,其中,2例放置2枚支架。10例放置1次成功,2例放置2次成功。所有病例梗阻症状均明显缓解,并逐渐能进半固体软食,生活质量明显提高。随访2～18个月,2例出现支架梗阻后再次置入支架,1例胆道梗阻行胆道外引流术。未发生出血、穿孔、支架移位等严重并发症。结论金属支架是胃流出道恶性梗阻安全有效的治疗方法,可迅速缓解症状,改善患者体质,提高患者的生活质量,结合化疗有望延长患者的生存期。     

Covered stent placement in patients with recurrent cancer after a Billroth I reconstruction

PURPOSE: To assess the technical feasibility and clinical effectiveness of covered stent placement in patients with recurrent malignant obstructions after Billroth I reconstruction. MATERIALS AND METHODS: From June 1997 to November 2005, 16 patients underwent covered stent placement for recurrent gastric cancer after Billroth I reconstruction. A total of 19 covered stents were used, including 14 dual stents and five fully covered stents, as available. RESULTS: Stent placement was technically successful in all patients, with 13 of 16 patients (81%) showing improvement of symptoms. Stent migration occurred in one patient, tumor ingrowth in one, and stent collapse and/or bowel perforation in one. Nine patients (56%) had concomitant (n=7) or subsequent (n=2) biliary obstruction. One patient was lost to follow-up. The remaining 15 patients died 5-628 days (median, 52 days; mean, 120 days) after stent placement due to progression of disease or pneumonia. CONCLUSIONS: Placement of covered metallic stents is feasible and effective in patients with recurrent malignant obstruction after Billroth I reconstruction.     

Fluoroscopic-guided covered metallic stent placement for gastric outlet obstruction and post-operative gastroenterostomy anastomotic stricture.

AIM: To evaluate the feasibility and safety of fluoroscopic-guided covered metallic stent placements in providing palliative care for patients with inoperable malignant gastric outlet obstruction. MATERIALS AND METHODS: Under fluoroscopic guidance, placement of self-expandable, covered stents was attempted in 20 patients with inoperable or recurrent gastric cancer (age range 36-79 years). All patients had inoperable gastric outlet obstruction, 13 with native anatomy and seven with post-operative anatomy (gastrointestinal anastomotic sites). All patients had intolerance to oral alimentation and/or vomiting after ingestion. Success was defined both technically and clinically. RESULTS: The placement of the stent was technically successful in 18 patients and failed in two patients (technical success: 90%). The cause of the technical failures was an inability to negotiate the guide wire through the obstruction sites in spite of the use of both fluoroscopic and endoscopic guidance. After stent placement, 15 patients were able to ingest at least liquids and had a markedly decreased incidence of vomiting (clinical success: 75%). During the mean follow-up of 6 weeks, there have been no stent reocclusion and no life-threatening complications except migration of two stents in one patient. CONCLUSION: Fluoroscopically guided covered metallic stent placement appears to be valuable for the palliative treatment of malignant obstruction of gastric outlet and post-operative gastrointestinal anastomoses.     

Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents

PURPOSE: To assess the usefulness of flexible covered metallic stents in the palliation of malignant obstruction of the gastric outlet and duodenum. MATERIALS AND METHODS: Twenty-four consecutive patients with malignant obstruction of the gastric outlet (n = 22) or duodenum (n = 2) underwent palliative treatment with self-expandable flexible covered metallic stents. Fourteen patients had advanced gastric carcinoma at the antrum and/or pylorus, and eight had obstruction at the anastomosis site of previous gastrojejunostomy. Complications and clinical status were investigated during the study period. RESULTS: The technical success rate was 75% (18 of 24 patients). Twenty-one stents were placed in 18 patients by using an introducer 6 (n = 7) or 8 mm (n = 14) in diameter. The mean follow-up period was 3.4 months (range, 1 week to 9 months). Symptoms improved in 12 (67%) patients after the procedure. There was no change in symptoms in five and a decrease in one. Twelve patients died during the follow-up period (mean survival, 4.3 months). The complication rate was 25% (six of 24 patients), including stent migration (n = 5) and fracture (n = 3). CONCLUSION: Flexible covered metallic stent placement can be useful for palliation in patients with malignant obstruction of the gastric outlet or duodenum.     

Palliation of malignant gastric outlet obstruction after oesophagectomy by percutaneous transthoracic placement of an expanding metal stent

Self-expanding stents can be used in the palliative management of strictures in the oesophagus, gastric outlet, bile duct and lower gastrointentinal tract [1-4]. Successful stent deployment depends on satisfactory positioning of the assembly device across the stricture. Previous reconstructive surgery may prevent precise endoscopic stent placement. This case report describes percutaneous transthoracic stenting of gastric outlet obstruction due to malignant external compression three years after oesophagectomy. Lyburn, I. (2001). Clinical Radiology56, 82-83.     

胃十二指肠良恶性狭窄的内支架治疗

目的探讨金属内支架在治疗不能手术的胃十二指肠交界处良恶性梗阻中的作用、疗效和并发症。方法１１例病人，８例术后吻合口复发狭窄，１例胃幽门良性狭窄，２例恶性狭窄。在透视监视下，使用介入放射学方法置入１１个自膨胀式金属内支架。结果１１例病人支架置入均成功，１０例梗阻症状立即解除，随访期间病人均能进食，疗效满意。本组无严重并发症发生。结论介入放射学置入金属内支架是一个简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas

PURPOSE: To evaluate delayed complications after esophageal expandable metallic stent placement. MATERIALS AND METHODS: From April 1993 to December 1997, 90 expandable metallic stents were placed in 82 consecutive patients with inoperable malignant esophageal obstruction (n = 49) or malignant esophagorespiratory fistula (n = 33). Stents used included covered Gianturco-Rosch Z stents (n = 20), Wallstents (covered, n = 31; uncovered, n = 13), and Ultraflex stents (covered, n = 8; uncovered, n = 10). Patients were followed prospectively and monitored for delayed complications, defined as major (hemorrhage, tracheal compression, stent migration, perforation or fistula formation, granulomatous obstruction, tumor ingrowth and overgrowth, funnel phenomenon, and stent covering disruption) or minor (reflux, chest pain, and food impaction). RESULTS: Mean survival was 4.5 months after stent placement (range, 3 weeks to 26 months). The overall incidence of delayed complications was 64.6%, with 17 patients (20.7%) experiencing more than one complication. The rates of delayed complications in patients with Z stents, Wallstents, and Ultraflex stents were 75.0%, 68.1%, and 44.4%, respectively (P <.05). Most complications were life-threatening and occurred more frequently when stents were placed in the proximal third of the esophagus, compared with more distally (P <.05). Thirteen patients (15.9%) died from complications directly related to stent placement. CONCLUSION: Esophageal stent placement for malignant obstruction or fistula is associated with a substantial incidence of delayed complications.     

Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents

PURPOSE: To assess whether coaxial placement of uncovered and covered expandable nitinol stents overcomes the disadvantages of the increased migration rate seen with covered stents and the tumor ingrowth seen in uncovered stents in the treatment of malignant gastric outlet obstructions. MATERIALS AND METHODS: Two types of expandable nitinol stent were designed: an uncovered stent and a covered stent. Under fluoroscopic guidance, the uncovered and covered stents were placed coaxially with complete overlap in 39 consecutive patients with malignant gastric outlet obstruction caused by stomach cancer. Food intake capacity was graded on a scale of 0-4. Stent patency rate was estimated by the Kaplan-Meier method. RESULTS: Technical success rate was 97% (38 of 39 patients). After stent placement, food intake capacity improved at least one grade in 36 patients. Stent migration occurred in three patients (8%), that is, partial (n = 2) or complete (n = 1) upward migration of the inner covered stent into the stomach. Two of these patients were treated by placement of an additional covered stent. During the mean follow-up period of 134 days (range, 15-569 d), 10 patients developed recurrent symptoms of obstruction with tumor overgrowth being the most common cause. Nine underwent placement of an additional covered stent with good results. The median period of primary stent patency was 157 days (mean, 278 d). The 30-, 60-, and 180-day patency rates were 97%, 91%, and 39%, respectively. Four patients (10%) died within 1 month after the procedure. CONCLUSION: Coaxial stent placement technique seems to contribute to decreasing the migration rate of the stent and decrease the rate of recurrent obstruction by preventing or delaying tumor ingrowth.     

Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation

PURPOSE: To determine the effectiveness and safety of metallic stents in the treatment of malignant colorectal obstruction before surgery and for palliation. MATERIALS AND METHODS: Eighty patients with acute malignant colorectal obstruction presumed to be malignant were treated by means of implanting self-expanding metallic stents. RESULTS: Stent placement was successful in 70 of the 80 patients and resolved bowel obstruction in 67 patients (96%). Two patients had colonic perforation and developed peritonitis 18 and 24 hours after stent placement; one patient died as a consequence. Thirty-three patients underwent elective surgery after 7 days +/- 3 (SD; range, 4-10 days), and adequate tumoral coverage and cleansing of the colon were observed in all patients. Stent placement was used as final palliative treatment in another 35 patients. Patient follow-up lasted a mean of 138 days +/- 93 (range, 36-334 days). The survival rate for the palliative group was 55% at 3 months, 44% at 6 months, and 25% at 9 months. The estimated primary stent patency rate was 91% at 3 and 6 months. CONCLUSION: Management of colorectal obstruction by using metallic stents was effective and safe, although colonic perforation is a potential complication. In cases of palliation, the method may obviate palliative colostomy.     

Gastric and Duodenal Stents: Follow-Up and Complications

Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered. Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy. Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE ± 4.6). Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.     

胃十二指肠恶性梗阻内支架治疗12例报告

目的 用金属内支架缓解不能手术的胃十二指肠恶性梗阻患者的症状。资料与方法 12例胃十二指肠恶性梗阻患者均有反复恶心呕吐症状，且不能手术治疗。在透视监视下，使用介入放射学方法置入13个自膨胀式金属内支架。结果 12例患者支架置入均成功，随访期间患者均能进食，呕吐减轻，生活质量提高。无严重并发症发生。结论 金属内支架置人是一种简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

Expandable Metal Stents for the Palliation of Malignant Gastroduodenal Obstruction

Purpose: Gastric outlet obstruction is a debilitating complication of upper gastrointestinal malignancy. We present our experience with insertion of self-expanding metal stents (SEMS). Methods: Twenty-eight patients were referred, stenting being attempted in 23. Two patients had esophageal Wallstents inserted through a gastrostomy; 21 had an endoscopic approach with enteral Wallstents. Results: One stent insertion failed, ten patients (45%) returned to a normal diet, ten patients (45%) managed semi-solid food and two patients (9%) had no significant improvement. No immediate complications were seen. One patient subsequently developed pancreatitis. Reintervention (4 stents, 1 jejunostomy, 1 gastrojejunostomy) was required in six of 22 patients (27%) for inadequate stent expansion (1), second stricture (2), stent migration (1), and tumor ingrowth (2). The mean survival was 95.4 days (SD 78.8 days, range 3–230 days). The mean follow-up time was 98.9 days (SD 86.7 days, range 3–309 days). Conclusions: SEMS are effective in palliating malignant gastric outlet obstruction. A combined endoscopic/fluoroscopic approach allows the most complete assessment of the stricture and removes the need for gastrostomy insertion. Careful assessment of the gastrointestinal tract distal to the lesion is important.     

防反流覆膜支架在晚期食管下段癌及贲门-胃底癌治疗中的临床应用

目的：评价防反流覆膜支架在晚期食管下段癌及贲门-胃底癌治疗中的临床疗效。方法：选择晚期食管下段癌和贲门-胃底癌38例为治疗组,35例为对照组,在胃镜介导下对治疗组放置防反流覆膜支架,对照组放置普通覆膜支架,术后观察支架植入成功率、梗阻改善状况及反流状况。结果：治疗组和对照组支架成功率均为100％,梗阻均有明显改善,但两组支架植入后食管反流状况有一定的差异。结论：胃镜下放置防反流覆膜支架是治疗晚期食管癌和贲门-胃底癌理想的方法之一,不但能解决癌性梗阻,提高患者的生存质量,还能防止支架植入后胃液反流并发症的出现。     

Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

ObjectiveTo assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy.Materials and MethodsBetween July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated.ResultsThe stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively.ConclusionPercutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.     

Initial experience with Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction.

PURPOSE: Initial experience with use of Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction is reported. MATERIALS AND METHODS: Sixteen consecutive patients with malignant gastroduodenal obstruction were treated with peroral placement of Song's covered duodenal stent. The mean age was 58 years (range, 28-90 y). Gastroduodenal obstruction was caused by gastric (n = 8), metastatic (n = 2), gallbladder (n = 3), pancreatic (n = 2), or ampullary (n = 1) cancer. The disease was considered inoperable in all patients. With use of a flexible 20-F introducing system, seven fully covered, three uncovered, and 10 partially covered duodenal stents were placed under fluoroscopic guidance. RESULTS: The technical success rate was 94% (15 of 16) with no major complications. Symptoms of gastroduodenal obstruction improved in 14 patients. Stent migration was observed in three of seven fully covered stents. Patients with migrated stents required endoscopic stent removal and placement of uncovered duodenal stents. Tumor ingrowth was observed in two thirds of uncovered stents. In the 10 procedures with partially covered duodenal stents, no migration or tumor ingrowth was observed. All patients died 1-48 weeks (mean, 12 weeks) after stent placement. CONCLUSION: Peroral placement of Song's covered duodenal stent is a feasible and effective method of palliation in the majority of patients with malignant gastroduodenal obstruction. Migration of fully covered stents and tumor ingrowth of uncovered stents are important limitations that can be overcome with the use of a partially covered duodenal stent.     

Use of stents in the palliative treatment of malignant gastric outlet and duodenal obstruction

AIM: To evaluate the efficacy of stenting in the palliation of malignant duodenal and gastric outlet obstruction. MATERIALS AND METHODS: We retrospectively reviewed our series of patients who underwent stenting for malignant upper gastrointestinal obstruction between March 1998 and December 1999. From January 2000 data have been acquired prospectively. Our series comprises 21 stents successfully deployed in 15 patients. RESULTS: The technical and clinical success was 93% (14/15 patients). One patient required endoscopic negotiation of recurrent gastric carcinoma at the gastrojejunostomy site after failure to cross the lesion fluroscopically. Two patients required re-intervention 2 and 5 weeks after initial stent placement, for migration and ingrowth respectively. Eighteen stents were placed transorally, two stents transhepatically and one via a transgastric approach. Early complications (pain < 3 days) occurred in two patients (13%) and late complications (ingrowth, overgrowth and migration) occurred in three patients (20%). The median survival was 2.4 months (range 2-4 months). CONCLUSION: Stenting provides a less invasive palliative option than surgery with the advantage of lower morbidity and complication rates. It has the advantage of high technical and clinical success rates facilitated by alternative routes of access into the upper gastrointestinal tract via transgastric and transhepatic routes in addition to the traditional peroral route.     

Complications of biliary and gastrointestinal stents: MDCT of the cancer patient

OBJECTIVE: The goal of this article is to discuss and show the common complications of biliary and gastrointestinal stents as depicted by MDCT in cancer patients. Major complications include stent misplacement or displacement, bleeding, obstruction, perforation, stent fracture or collapse, and infection. This topic encompasses several relevant issues, including interpretative difficulties, therapeutic decisions, and potential malpractice concerns. CONCLUSION: Awareness and methodical assessment of stents could allow detection of stenting complications, potentially sparing the patient from associated morbidity and mortality.     

An unusual complication of oesophageal stent deployment

Insertion of a self-expanding metal stent is commonly used to palliate dysphagia secondary to oesophageal carcinoma. Displacement of the stent itself is a recognized complication which can result in perforation of the upper gastrointestinal tract. We report the first case of bowel obstruction and perforation resulting from the olive of the deployment system. This was probably due to peritoneal deposits on the small intestine obstructing passage of the olive.     

Retrieval of Migrated Colonic Stents from the Rectum

Palliative stenting of malignant colonic obstruction may be complicated by stent migration. Stents that migrate into the rectum cannot be passed with bowel movements and frequently cause obstruction. We present two simple means to retrieve stents from the rectum using fluoroscopic guidance. These techniques were used successfully without complication in four stent migrations. Received: 0/00/00/Accepted: 0/00/00     

Small bowel phytobezoars: detection with radiography

The authors reviewed the radiographic findings in 19 patients with phytobezoars of the small bowel. The most common predisposing causes were previous gastric outlet surgery and persimmon ingestion. Twelve patients underwent contrast material-enhanced studies of the upper gastrointestinal tract, and one patient underwent a barium enema study. These examinations revealed four gastric, two duodenal, and eight small bowel phytobezoars in 10 patients. The obstruction caused by small bowel phytobezoars frequently occurred in the jejunum or proximal ileum, more proximally than has been reported in previous series. Barium studies are useful in differentiating obstruction due to postoperative adhesions from obstruction caused by bezoars. In addition, barium studies enable the detection of residual gastric bezoars. This information has important implications in patient treatment because bezoar obstruction is unlikely to respond to conservative treatment, and concurrent gastric bezoars must be removed to prevent recurrent bowel obstruction.