Self-expanding metallic stents in the management of pyloric dysfunction after gastric pull-up operations

Abstract

The purpose of this paper is to report the use and benefits of self-expanding metallic stents employed in pyloric dysfunction. Four patients treated with oesophagectomy and gastric pull-up for oesophageal carcinoma failed to respond to balloon dilatation for pyloric dysfunction. Three of the patients were thought to have residual tumour at sites remote from the pylorus prior to stenting, but the fourth, who had undergone surgery 8 years previously, was thought to be cured. All were treated with self-expanding metallic stents. All four patients responded well with resolution of their symptoms. Over a mean follow-up of 6 months there has been no recurrence of symptoms. Stent insertion represents a potentially valuable method of treatment in patients with post-surgical pyloric dysfunction in whom simple balloon dilatation has failed.

Treatment of a malignant stenosis of the corpus of the stomach with a self-expanding stent

“…Various authors report the usefulness of stents in palliating malignant obstruction of the upper gastrointestinal tract [1,2,3,4,5,6,7,8,9,10,11]. Treatment with placement of bare stents or covered stents has been shown to be effective in patients with dysphagia due to malignant esophageal strictures [1,2,3,4,5].…”

“…The distal end is extended to its maximal diameter due to lack of resistance (arrowheads) cessful. However, numbers of patients are small and follow-up is limited [6,7,8,9,10,11]. Due to the wide lumen of the normal gastric corpus, stent implantation is hardly ever necessary at this particular site.…”

“…To date, there are approximately 60 reported cases of stenting as a therapeutic option in gastroduodenal outlet obstruction [6,7,8,9,10,11]. Due to the wide lumen of the normal gastric corpus, stent implantation is hardly ever necessary at this particular site [10,11].…”

Gastroduodenal and Colonic Stents: Review Article

“…4 Other causes include benign lesions, such as peptic strictures of the gastric outlet or duodenum, 5 and pyloric dysfunction after gastric pull-up operation for esophageal carcinoma. 6 Patients with gastric outlet or duodenal obstruction often exhibit intractable vomiting and are unable to eat. The consequences are gastric distension, weight loss, and dehydration that may require treatment with intravenous administration of fluids.…”

“…Similarly, selected patients with pyloric dysfuntion after gastric pull-up operation for esophageal resection can also be treated with self-expanding stents. 6 Apart from clinical or radiologic signs of gastrointestinal perforation, stent placement is not con-traindicated so long as the guidewire can be safely passed across the obstruction.…”