Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Abstract

Background Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems.Recurrent obstructive symptoms were caused by tissue/ tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach.

Feasibility of Self-Expandable Metal Stent Placement with Side-Viewing Endoscope for Malignant Distal Duodenal Obstruction

“…In a previous study using the gastroscope, SEMS insertion to distal duodenum or proximal jejunum failed in more than half of all cases, and the colonoscope was used for successful SEMS placement in these cases [6]. Our study showed similar results.…”

“…Median survival was 153 days, which is comparable to ours (134 days), but stent patency was not reported in this study [6].…”

“…Technical and clinical success rates were both 93 % and severe complication did not happen. However, recurrent obstruction occurred in 44 %, and reintervention was performed in all cases [6].…”

“…Technical success was defined as stent placement across the entire length of the stricture and radiologic relief of obstruction. To assess clinical success, the standardized gastric outlet obstruction scoring system (GOOSS) was used: 1 = no oral intake, 2 = liquids only, 3 = soft solids, and 4 = full diet [4,6,10]. Clinical success was defined as improvement of oral intake greater than score 2 within a week after the procedure.…”

“…The insertion of SEMSs to the esophagus, stomach, or proximal duodenum can be performed easily using forward-viewing gastroscopes with large channels [5]. However, insertion to the distal duodenum or proximal jejunum can be challenging because of the limits in the length and/or flexibility of gastroscopes [6].…”