Transhepatic Assisted Transoral Placement of a Duodenal Stent in Malignant Gastric Outlet Obstruction

Milson, Alexander; Abdellaoui, Adel; Fraser, Clementine; Watkinson, Anthony

doi:10.1016/j.jvir.2009.12.386

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…12,13 However permanent external drainage is a very unsatisfactory outcome, leaving the patient disfigured by a drainage bag full of bile and the carers with the challenge of maintaining it. Reports of transhepatic placement of enteral stents are rare [14][15][16][17][18] and we have only found one previous case of direct percutaneous enteral stent insertion for Roux loop obstruction. 7 With adoption of techniques used for other interventions it should be possible to achieve internal drainage in most cases, but a number of careful considerations are required.…”

Section: Discussionmentioning

confidence: 85%

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Laasch

2010

Gut Liver

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Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed. (Gut Liver 2010; 4(Suppl. 1):S89-95)

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Section: Discussionmentioning

confidence: 85%

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Laasch

2010

Gut Liver

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“…It is usually feasible to cross most strictures with a guidewire by using a coalescence of fluoroscopy and endoscopy. This, however, may not be possible with very tight stenoses, in which case a surgical bypass may be needed [ 10 ]. Although endoscopically placed stents should be the ideal standard of care by a gastroenterologist, where endoscopy can be used for bowel decompression, dilation of strictures, or placement of self-expandable metal stents to restore the luminal flow either as a definitive treatment or to allow for a delay until elective surgical therapy [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to comorbidities, refusal of open surgery, and failed endoscopic trans-gastric attempts, this interventional technique was offered. Self-expandable metallic stents are effective in palliation, offering a rapid relief of benign gastric outlet obstruction [ 10 , 12 , 14 ]. Thus, they should be contemplated in patients with poor prognosis, whereas patients with a fairer prognosis should be offered a surgical bypass [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Trans-Biliary Gastric Outlet Recanalization and Stenting: A Case Report

Qazi¹,

Elzahrani²,

Tatwani³

et al. 2022

Cureus

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Gastric ischemia is a condition of hypo-perfusion associated with hypotension, vasculitis, and thromboembolism. We report a case of a gastric outflow obstruction due to sizeable visceral artery thromboembolism leading to the ischemic conclusion, the frailty, multiple comorbidities deeming general anesthesia (GA) risky, and the patient's decision not to have an open surgery under GA. Invasive procedures in patients with similar profiles like our patient are usually not risk-free, this leads the intervention radiology team to believe a minimally invasive procedure while avoiding GA might be optimal. A 63-year-old female with multiple comorbidities came eight weeks after significant surgery complaining of severe acute epigastric pain, abdominal distention and rigidity, and persistent vomiting. Further investigations showed obstruction in the gastric antrum and pyloric canal. Three separate endoscopic attempts to find and cross the stricture failed. Firstly, gastrostomy access was established, but due to the stomach being massively distended, passing a guidewire through the pylorus failed despite using multiple hydrophilic wires and pre-shaped catheters, this is due to the collapsed pylorus. Subsequently, two attempts under ultrasound guidance to puncture the duodenal bulb and pass a wire and catheter through the antrum stricture were unsuccessful, and another attempt was considered of high risk. An alternative approach through the gallbladder was established, and cholangiography was performed to delineate the anatomy. Then an approach through the right hepatic duct and ampulla of Vater was successfully performed. The attempted passage through the stricture was successful. The dilation was successful, and the patient tolerated both fluid and solids orally. Due to having such a frail patient, interventions of minimal invasiveness and favorable outcome are welcomed. This case report suggests that this technique showed satisfactory results and achieved the goal to improve the overall quality of life where the patient had a good oral intake with no post-operation complications.

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“…Sometimes, the tumor compromises not only the biliary duct but also the duodenum. For those patients, a duodenal stent placed per-orally, [42][43][44][45][46][47][48][49][50] through a percutaneous gastrostomy 51 or through the biliary access at the same time as the biliary stent placement is a good option. [52][53][54] Regarding the biliary access, there are two possible situations: the duodenal stenosis is distal to the papilla or proximal.…”

Section: Techniques In Complex Biliary Drainagementioning

confidence: 99%

Complex percutaneous biliary procedures: Review and contributions of a high volume team

Houghton

2019

Gastrointestinal Intervention

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A comprehensive literature review was performed to evaluate the state of art and level of evidence of complex percutaneous biliary procedures and their safeness and effectiveness. Amidst those procedures, the review focused on techniques to achieve non-dilated biliary drainage, multiple selfexpandable metallic stents, multiple plastic stents for the treatment of benign biliary strictures, simultaneous biliary and duodenal stent placement, rendezvous maneuvers, and use of magnets to treat biliary stenosis or even create new anastomosis with the jejunum or duodenum. A description of each technique and revision of literature provides useful tools for clinical practice decisions.

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Transhepatic Assisted Transoral Placement of a Duodenal Stent in Malignant Gastric Outlet Obstruction

Cited by 4 publications

References 15 publications

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Trans-Biliary Gastric Outlet Recanalization and Stenting: A Case Report

Complex percutaneous biliary procedures: Review and contributions of a high volume team

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