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Percutaneous transhepatic access to allow per-oral enteric stent insertion for malignant duodenal obstruction following failed endoscopic attempt

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초록

The treatment options for malignant gastric outlet obstruction include antegrade stent placement or surgical bypass, the latter being associated with a higher level of morbidity and therefore often reserved for cases in which stenting is not technically possible. Antegrade stent placement can be endoscopic, fluoroscopic or a combination. We report a case in which standard antegrade attempts at stenting failed, but where it was possible to use a retrograde approach via the biliary tree to facilitate technically and clinically successful stent placement.

Abstract

The treatment options for malignant gastric outlet obstruction include antegrade stent placement or surgical bypass, the latter being associated with a higher level of morbidity and therefore often reserved for cases in which stenting is not technically possible. Antegrade stent placement can be endoscopic, fluoroscopic or a combination. We report a case in which standard antegrade attempts at stenting failed, but where it was possible to use a retrograde approach via the biliary tree to facilitate technically and clinically successful stent placement.

참고문헌 (7)

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  2. Yim HB, "Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction", Gastrointest Endosc, 53, pp.329~332 (2001)
  3. Del Piano M, "Endoscopy or surgery for malignant GI outlet obstruction?", Gastrointest Endosc, 61, pp.421~426 (2005)
  4. Miller BHT, "An assessment of radiologically inserted transoral and transgastric gastroduodenal stents to treat malignant gastric outlet obstruction", Cardiovasc Intervent Radiol, 36, pp.1591~1601 (2013)
  5. Johnsson E, "Transhepatic placement of an enteral stent to treat jaundice in a tumor recurrence obstructed afferent loop after a whipple procedure", Dig Surg, 20, pp.329~331 (2003)
  6. Laasch HU, "Obstructive jaundice after bilioenteric anastomosis: transhepatic and direct percutaneous enteral stent insertion for afferent loop occlusion", Gut Liver, 4(Suppl 1), pp.S89~S95 (2010)
  7. Hosokawa I, "Percutaneous transhepatic metallic stent insertion for malignant afferent loop obstruction following pancreaticoduodenectomy : a case report", J Med Case Rep, 6, pp.198~ (2012)

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