Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

Abstract

In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent (SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time (stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.

Experience with Balloon Dilatation in Crohn’s and Non-Crohn’s Benign Small-Bowel Strictures: Is There a Difference?

“…The remaining two cases were unable to endure an operation because of poor general conditions. Recently, endoscopic metallic stent placement has been performed as palliative treatment for malignant stenosis [22–24]. For benign strictures, however, the treatment has not been standardized and there is currently no consensus on whether surgical or medical treatment is more appropriate.…”

Roles of Capsule Endoscopy and Device-Assisted Enteroscopy in the Diagnosis and Treatment of Small-Bowel Tumors

“…In a small case series, a self-expandable metallic stent was inserted for malignant small-bowel obstruction using a colonoscope in one patient and using the throughthe-overtube technique in two patients. 38 In a Korean study of 19 patients with small-bowel obstruction due to metastatic cancer, technical success was achieved in 18 cases (94.7%) in which a conventional endoscope was used after passing a guidewire using an enteroscope with or without ballooning. 39 However, stent insertion for malignant small-bowel obstruction can be impossible if the lesion is located in the deep small bowel, which is difficult to reach using DAE.…”

“…However, the working channel of the DAE instrument is small for inserting the stent device, and it is impossible to insert the stent using the through-the-scope deployment method. In a small case series, a self-expandable metallic stent was inserted for malignant small-bowel obstruction using a colonoscope in one patient and using the throughthe-overtube technique in two patients [ 38 ]. In a Korean study of 19 patients with small-bowel obstruction due to metastatic cancer, technical success was achieved in 18 cases (94.7%) in which a conventional endoscope was used after passing a guidewire using an enteroscope with or without ballooning [ 39 ].…”