Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction

Abstract

Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines.

Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review

“…During a PubMed search, we found 12 reports (23 patients) on the use of SEMS to treat malignant ALO that arises after PD (Table 3). [5][6][7][8][9][10][11][12][13][14][15][16] Clinical success was achieved in all cases, and no adverse events were encountered. Although the data were limited, no cases of SEMS obstruction were found.…”

“…Recently, the use of balloon-assisted endoscopy during SEMS placement for malignant ALO has been reported. 4,7,9,[11][12][13][14]16 Shimatani et al reported a case in which SEMS placement was used to treat ALO caused by cancer recurrence after PD, in which a newly developed, shorttype, double-balloon endoscope (S-DBE) (EI-580BT; Fujifilm, Tokyo, Japan) was used. 13 They claimed that the combined use of the new S-DBE, which had a 3.2-mm working channel, and SEMS with a 9 Fr delivery system enabled through-the-scope SEMS placement, which had been previously challenging because the large diameter of the SEMS delivery system did not allow stent deployment through the 2.8-mm working channels of the conventional S-DBE.…”

Impact of a Newly Developed Short Double-Balloon Enteroscope on Stent Placement in Patients with Surgically Altered Anatomies

“…Conventional DBE could never allow gastrointestinal metal stent placement for malignant gastrointestinal obstruction such as an afferent-loop obstruction, because of the narrow working channel of the scope. Therefore, one common practice is to insert the conventional DBE to the stricture and subsequently remove it, leaving the overtube; the self-expandable metal stent is then placed through the over-tube under fluoroscopic guidance 7,8. This technique is useful, but stent placement using the new scope, and the through-the-scope method, as in our case, is more ideal for achieving correct and safe stent placement 9…”

Percutaneous Transhepatic Self-expanding Metallic Stent Placement for the Treatment of Malignant Afferent Loop Obstruction

“…Several cases involving the endoscopic placement of an SEMS for malignant ALO have been reported since the development of DBE- and TTS-type SEMSs ( 2 - 5 ). A few reports have described a combined method in which a DBE is used with an overtube because the large diameter of the SEMS delivery system does not allow for stent deployment through the 2.8-mm working channel of a conventional short DBE ( 2 , 3 ). However, the combined use of the new short-type DBE with a 3.2 mm working channel and TTS SEMS enables easy SEMS placement ( 5 ).…”