Early massive bleeding after duodenal self-expandable metal stent placement for palliation of malignant gastric outlet obstruction (with video)

Saleem, Atif; Bakken, Johan C.; Baron, Todd H.

doi:10.1016/j.gie.2010.12.034

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…A case of massive bleeding within 72 hours of duodenal SEMS placement, similar to our case of early bleeding, has been reported. 23 The author of the case report had hypothesized that the massive bleeding was caused due to a combination of tumor infiltration into the vessel, dilation of the stricture, and the presence of the selfexpandable metal duodenal stent. The same findings were also seen in the CT imaging performed before SEMS placement, in all our cases that presented with early bleeding postoperatively (Figures 2 and 3).…”

mentioning

confidence: 99%

<p>Efficacy and Adverse Effects of Self-Expandable Metal Stent Placement for Malignant Duodenal Obstruction: The Papilla of Vater as a Landmark</p>

Wu¹,

Lee²,

Tsou³

et al. 2020

CMAR

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Self-expandable metal stents are used for malignant duodenal obstruction. Outcomes between stents placed above and below the papilla of Vater differ, and no study has investigated these differences. We evaluated the efficacy and adverse events of stent placement in these two locations and reported our experience with self-expandable metal stent placement in patients. Patients and Methods: We retrospectively analyzed the data of patients with unresectable metastatic cancers (n = 101), who underwent successful duodenal self-expandable metal stent placement between 2008 and 2018. Patients were divided into above and below the papilla of Vater groups. Patient demographics, technical and clinical outcomes, post-procedural morbidity, and stent patency were analyzed. Results: Overall, 71 and 30 patients had intestinal obstruction above (including the papilla itself) and below the papilla of Vater and underwent successful stenting. Common bile duct obstruction was more common in the above-papilla group. Procedure time was similar between the groups, if an appropriate endoscope could facilitate stent placement in the below-papilla group. Both groups achieved symptomatic relief. Median stent patency duration was not significantly different between the groups; three patients had severe gastrointestinal bleeding due to postoperative vascular-enteric fistula. Conclusion: Self-expandable metal stents can effectively relieve symptoms of duodenal obstructions located above and below the papilla of Vater. Duodenoscopes could facilitate stent placement if the obstruction is located below the papilla of Vater; if gastrointestinal bleeding occurs postoperatively, the possibility of vascular-enteric fistula formation should be considered.

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mentioning

confidence: 99%

<p>Efficacy and Adverse Effects of Self-Expandable Metal Stent Placement for Malignant Duodenal Obstruction: The Papilla of Vater as a Landmark</p>

Wu¹,

Lee²,

Tsou³

et al. 2020

CMAR

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“…Although technical and clinical success rates of SEMS for treating benign gastro duodenal obstruction have been well established, their long-term consequences remain to be elucidated. Severe complications i.e., bleeding and perforation are rare and mainly present in the early postprocedural period (4,7). To the best of our knowledge, this is the first case of a late onset complication due to a self-expandable stent placed for benign gastro duodenal obstruction, occurring over than 9 years after the index procedure.…”

Section: Discussionmentioning

confidence: 90%

“…Self-expandable metal stent (SEMS)designated originally for the treatment of malignant obstructive lesions-represent a sophisticated therapeutic option (1). To date, several reports of SEMS placement for benign pyloric stenosis have been published; however, data regarding their long term efficacy and safety in particular, remain limited (2)(3)(4)(5)(6). Herein, we present the management of a late onset stent induced iatrogenic complication in a patient suffering from peptic ulcer disease consequence, aiming to underline that innovation does not necessarily correlate with quality of care.…”

Section: Introductionmentioning

confidence: 99%

Adhering to quality medical care: a case report of upper gastrointestinal bleeding due to self-expandable metal stent placed for benign duodenal obstruction

et al. 2018

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Endoscopic placement of self-expandable metal stent (SEMS) is an efficient method for the palliative decompression of malignant gastro duodenal obstruction. However, its role in treating benign obstructive conditions is controversial. We herein present an unusual case of recurrent upper gastrointestinal (GI) bleeding episodes due to ischemic lesions induced by an uncovered SEMS placed several years before to treat post peptic ulcer pyloric obstruction. Patient's advanced age precluded any attempt for endoscopic or surgical removal of the stent and the patient was successfully treated only with proton pump inhibitors, remaining uneventful on the long term. This case speaks to the need for rational use of innovative treatment modalities for quality of care provision.

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“…Para evitar esta complicación debe valorarse la verdadera causa de la migración y verificar la pertinencia de una nueva prótesis. En otros estudios también se ha documentado migración luego de recibir quimioterapia, seguramente por la disminución del tamaño tumoral (23).…”

Section: Discussionunclassified

Complicaciones del uso de prótesis metálicas autoexpansibles como paliación de obstrucción maligna del tracto de salida gástrico

Oliveros¹,

Bonilla²,

Sánchez³

et al. 2019

Rev. colomb. cancerol.

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La colocación de prótesis metálicas autoexpansibles (PMA) constituye una forma de tratamiento común en las obstrucciones malignas al tracto de salida gástrico, pues consigue la resolución de los síntomas a corto plazo, con un riesgo aceptable de complicaciones. Objetivo: Evaluar la ocurrencia de complicaciones del procedimiento y su tratamiento. Métodos: Este trabajo tuvo un componente descriptivo sobre las complicaciones del uso de prótesis y su tratamiento y un componente de asociación respecto a la administración del tratamiento oncológico con intención paliativa y su resultado respecto a la supervivencia global. Se revisaron 150 pacientes desde enero de 2011 hasta julio de 2017 que requirieron este procedimiento en el Instituto Nacional de Cancerología (INC). Resultados: La etiología que más frecuentemente causó obstrucción del tracto de salida gástrico fue el cáncer de estómago, seguido del cáncer pancreatoduodenal, tumores malignos de la vía biliar y otros, incluso fuera del sistema digestivo. Se documentó un porcentaje de éxito técnico del 98,6% (148/150) y éxito clínico del 96% (146/150). Se identificó un 64% (N=96) de pacientes con enfermedad maligna en estadio IV y que tuvieron una incidencia de complicaciones tempranas del 11,33% (N=17) y tardías del 29,33% (N=44). La mayor parte de las complicaciones fueron tratadas por vía endoscópica y el 2,66% (N=4) de los pacientes necesitaron tratamiento quirúrgico. Conclusiones: Las complicaciones de la colocación de prótesis duodenales pueden ser manejadas en forma exitosa por vía endoscópica en la mayoría de los casos. Los pacientes que además de la colocación de prótesis recibieron tratamiento oncológico presentaron una mayor supervivencia estadísticamente significativa.

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Early massive bleeding after duodenal self-expandable metal stent placement for palliation of malignant gastric outlet obstruction (with video)

Cited by 5 publications

References 4 publications

<p>Efficacy and Adverse Effects of Self-Expandable Metal Stent Placement for Malignant Duodenal Obstruction: The Papilla of Vater as a Landmark</p>

<p>Efficacy and Adverse Effects of Self-Expandable Metal Stent Placement for Malignant Duodenal Obstruction: The Papilla of Vater as a Landmark</p>

Adhering to quality medical care: a case report of upper gastrointestinal bleeding due to self-expandable metal stent placed for benign duodenal obstruction

Complicaciones del uso de prótesis metálicas autoexpansibles como paliación de obstrucción maligna del tracto de salida gástrico

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