Clinical Endoscopy

Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy: Sun Gyo Lim, Chan Gyoo Kim; Clin Endosc 2024;57(5):571-580. Published online February 23, 2024; DOI: https://doi.org/10.5946/ce.2023.160

Abstract PDF PubReader ePub: Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.

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Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent: Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce; Clin Endosc 2024;57(2):209-216. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.022

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

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Tubular fully covered self-expandable metallic stents for endoscopic ultrasound-guided gastrojejunostomy: moving forward or taking a step back?
Rami G. El Abiad, Mouen A. Khashab
Clinical Endoscopy.2024; 57(2): 193. CrossRef
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clinical Endoscopy.2024; 57(5): 588. CrossRef
Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
Clinical Endoscopy.2024; 57(5): 571. CrossRef

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No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis: Shyam Vedantam, Rahil Shah, Sean Bhalla, Shria Kumar, Sunil Amin; Clin Endosc 2023;56(3):298-307. Published online May 22, 2023; DOI: https://doi.org/10.5946/ce.2022.299

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction.
Methods
Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed.
Results
Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%–95.2%) and 92.1% (95% CI, 68.4%–98.4%), clinical success rates of 88.6% (95% CI, 85.4%–91.1%) and 89.6% (95% CI, 79.0%–95.1%), adverse event rates of 11.4% (95% CI, 8.1%–15.9%) and 14.7% (95% CI, 4.4%–39.1%), and reintervention rates of 10.3% (95% CI, 6.7%–15.4%) and 3.5% (95% CI, 1.6%–7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40–9.18; p=0.008).
Conclusions
No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

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Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled magnetic anastomosis rings (DSAMARs) in a pig model
Miaomiao Zhang, Jianqi Mao, Jia Ma, Shuqin Xu, Yi Lyu, Xiaopeng Yan
BMC Gastroenterology.2024;[Epub] CrossRef
Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy
Dimitrios Ziogas, Thomas Vasilakis, Christina Kapizioni, Eleni Koukoulioti, Georgios Tziatzios, Paraskevas Gkolfakis, Antonio Facciorusso, Ioannis S. Papanikolaou
Medical Sciences.2024; 12(1): 9. CrossRef
Lumen-apposing metal stents: A primer on indications and technical tips
Sridhar Sundaram, Suprabhat Giri, Kenneth Binmoeller
Indian Journal of Gastroenterology.2024;[Epub] CrossRef
The Role of Luminal Apposing Metal Stents on the Treatment of Malignant and Benign Gastric Outlet Obstruction
Mihai Rimbaș, Kar Wai Lau, Giulia Tripodi, Gianenrico Rizzatti, Alberto Larghi
Diagnostics.2023; 13(21): 3308. CrossRef

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Early Lumen-Apposing Metal Stent Dysfunction Complicating Endoscopic Ultrasound-Guided Gastroenterostomy: A Report of Two Cases: Janine B. Kastelijn, Veronique Van der Voort, Alderina Bijlsma, Leon M. G. Moons, Matthijs P. Schwartz, Frank P. Vleggaar; Clin Endosc 2021;54(4):603-607. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.201

Abstract PDF PubReader ePub

Endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing metal stent has emerged as a novel technique in the palliative treatment of malignant gastric outlet obstruction. Endoscopic ultrasonography-guided gastroenterostomy seems to have the potential to provide long-lasting patency in a minimally invasive manner. Low reintervention rates have been described. We report two cases with early lumen-apposing metal stent dysfunction, compromising patency. One case showed food impaction after three weeks, and hyperplastic tissue overgrowth with a buried distal flange six weeks after stent placement. The latter was successfully treated by argon plasma coagulation, stent removal, and deployment of a larger-diameter lumen-apposing metal stent. The second case showed a narrowed luminal diameter of the stent and jejunal pressure ulcerations after three weeks. The narrowing was successfully treated by balloon dilation. Eight weeks later, hyperplastic tissue overgrowth at the distal flange of the stent and a gastro-colonic fistula were diagnosed, followed by extensive reconstructive surgery.

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International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process
Sebastian Stefanovic, Douglas G. Adler, Alexander Arlt, Todd H. Baron, Kenneth F. Binmoeller, Michiel Bronswijk, Marco J. Bruno, Jean-Baptiste Chevaux, Stefano Francesco Crinò, Helena Degroote, Pierre H. Deprez, Peter V. Draganov, Pierre Eisendrath, Marc
American Journal of Gastroenterology.2023;[Epub] CrossRef
Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Schalk W. van der Merwe, Roy L. J. van Wanrooij, Michiel Bronswijk, Simon Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Rastislav Kunda, Abdenor Badaoui, Ryan Law, Paolo G. Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F.
Endoscopy.2022; 54(02): 185. CrossRef

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Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction: Ryosuke Tonozuka, Takayoshi Tsuchiya, Shuntaro Mukai, Yuichi Nagakawa, Takao Itoi; Clin Endosc 2020;53(5):510-518. Published online September 23, 2020; DOI: https://doi.org/10.5946/ce.2020.151

Abstract PDF PubReader ePub

Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

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Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clinical Endoscopy.2024; 57(2): 209. CrossRef
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Pirogov Russian Journal of Surgery.2024; (4): 125. CrossRef
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Vinay Dhir, Cesar Jaurrieta‐Rico, Vivek Kumar Singh
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Outcomes of Endoscopic Ultrasound-guided Gastroenterostomy Using Lumen-apposing Metal Stent in the Treatment of Malignant and Benign Gastric Outlet Obstruction: A Case Series
Kannikar Laohavichitra, Jerasak Wannaprasert, Thawee Ratanachu-ek
Siriraj Medical Journal.2024; 76(4): 174. CrossRef
Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico
Massiel Madelin Rosario-Morel, Rodrigo Soto-Solis, Katia Picazo-Ferrera, Miriam Idalia Torres-Ruiz, José Alberto Estradas-Trujillo, Mario Alberto Gallardo-Ramírez, Gerardo Akram Darwich-del Moral, Luis Ariel Waller-González
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“Through-stent enterography”: first experience with a novel technique intended to improve safety in endosonography-guided gastroenterostomy
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iGIE.2024; 3(2): 247. CrossRef
Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
Clinical Endoscopy.2024; 57(5): 571. CrossRef
Long‐term outcomes of endoscopic double stenting using an anti‐reflux metal stent for combined malignant biliary and duodenal obstruction
Takashi Sasaki, Tsuyoshi Takeda, Yuto Yamada, Takeshi Okamoto, Chinatsu Mori, Takafumi Mie, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(1): 144. CrossRef
Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives
Michiel Bronswijk, Enrique Pérez‐Cuadrado‐Robles, Schalk Van der Merwe
Digestive Endoscopy.2023; 35(2): 255. CrossRef
The choice of a method for the correction of pyloric tumor stenosis
K.I. Salimzyanov, A.B. Ryabov, V.M. Khomyakov, S.S. Pirogov, D.D. Sobolev
Onkologiya. Zhurnal imeni P.A.Gertsena.2023; 12(2): 66. CrossRef
Dilation balloon-occlusion technique for EUS-guided gastrojejunostomy
Samuel Han, J. Royce Groce, Sajid Jalil, Somashekar G. Krishna, Luis M. Lara, Peter J. Lee, Hamza Shah, Georgios I. Papachristou
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Jia-Su Li, Kun Lin, Jian Tang, Feng Liu, Jun Fang
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Laurent Monino, Enrique Perez-Cuadrado-Robles, Jean-Michel Gonzalez, Christophe Snauwaert, Hadrien Alric, Mohamed Gasmi, Sohaib Ouazzani, Hedi Benosman, Pierre H. Deprez, Gabriel Rahmi, Christophe Cellier, Tom G. Moreels, Marc Barthet
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Bachir Ghandour, Michael Bejjani, Shayan S. Irani, Reem Z. Sharaiha, Thomas E. Kowalski, Douglas K. Pleskow, Khanh Do-Cong Pham, Andrea A. Anderloni, Belen Martinez-Moreno, Harshit S. Khara, Lionel S. D'Souza, Michael Lajin, Bharat Paranandi, Jose Carlos
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Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review
Roy L. J. van Wanrooij, Michiel Bronswijk, Rastislav Kunda, Simon M. Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Abdenor Badaoui, Ryan Law, Paolo Giorgio Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F. Binmoeller, Marc
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Stephanie Lok Hang Cheung, Anthony Yuen Bun Teoh
Gut and Liver.2022; 16(2): 190. CrossRef
Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis
Rajesh Krishnamoorthi, Shivanand Bomman, Petros Benias, Richard A. Kozarek, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Shayan S. Irani
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Endoscopic Management of Combined Biliary and Duodenal Obstruction: Zaheer Nabi, D. Nageshwar Reddy; Clin Endosc 2019;52(1):40-46. Published online January 10, 2019; DOI: https://doi.org/10.5946/ce.2018.102

Abstract PDF PubReader ePub

Combined obstruction of the bile duct and duodenum is a common occurrence in periampullary malignancies. The obstruction of gastric outlet or duodenum can follow, occur simultaneously, or precede biliary obstruction. The prognosis in patients with combined obstruction is particularly poor. Therefore, minimally invasive palliation is preferred in these patients to avoid morbidity associated with surgery. Endoscopic palliation is preferred to surgical bypass due to similar efficacy, less morbidity, and shorter hospital stay. The success of endoscopic palliation depends on the type of bilioduodenal stenosis and the presence of previously placed duodenal metal stents. Biliary cannulation is difficult in type II bilioduodenal strictures where the duodenal stenosis is located at the level of the papilla. Consequentially, technical and clinical success is lower in these patients than in those with type I and III bilioduodenal strictures. However, in cases with failure of endoscopic retrograde cholangiopancreatography, with the introduction of endoscopic ultrasound for biliary drainage, the success of endoscopic bilioduodenal bypass is likely to increase further. The safety and efficacy of endoscopic ultrasound-guided drainage has been documented in multiple studies. With the development of dedicated accessories and standardization of drainage techniques, the role of endoscopic ultrasound is likely to expand further in cases with double obstruction.

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Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction—A Retrospective, Multicenter Study: The B-GOOD Study
Alessandro Fugazza, Marta Andreozzi, Cecilia Binda, Andrea Lisotti, Ilaria Tarantino, Juan J. Vila, Carlos Robles Medranda, Arnaldo Amato, Alberto Larghi, Enrique Perez Cuadrado Robles, Giovanni Aragona, Francesco Di Matteo, Roberta Badas, Cesare Hassan,
Cancers.2024; 16(19): 3375. CrossRef
Double EUS-guided bypass for gastric outlet and biliary tract malignant obstruction: A standardized one-step approach (with videos)
Victor Lira de Oliveira, Marcos Eduardo Lera dos Santos, Mateus Bond Boghossian, João Remí de Freitas Júnior, Maria Luíza Lemos Pires Pereira, Carolina Vaz Turiani, Eduardo Guimarães Hourneaux de Moura
Endoscopic Ultrasound.2024; 13(4): 271. CrossRef
Combined endoscopic mAnagement of BiliaRy and gastrIc OutLET obstruction (CABRIOLET Study): A multicenter retrospective analysis
Giuseppe Vanella, Michiel Bronswijk, Roy LJ van Wanrooij, Giuseppe Dell'Anna, Wim Laleman, Hannah van Malenstein, Rogier P Voermans, Paul Fockens, Schalk Van der Merwe, Paolo Giorgio Arcidiacono
DEN Open.2023;[Epub] CrossRef
Clinical presentation and outcomes of pancreatic cancer at a tertiary care hospital in the sub-Himalayan region: A retrospective observational study
Amit Gupta, Deepak Rajput, Shyam Karuppusamy Krishnasamy, Oshin Sharma, Rahul Mishra, Amoli Tandon, Sweety Gupta
Cancer Research, Statistics, and Treatment.2023; 6(1): 44. CrossRef
Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis
Rajesh Krishnamoorthi, Shivanand Bomman, Petros Benias, Richard A. Kozarek, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Shayan S. Irani
Endoscopy International Open.2022; 10(06): E874. CrossRef
Concomitant endoscopic biliary, duodenal and colonic stent placement for advanced carcinoma of gall bladder
Sridhar Sundaram, Sidharth Harindranath, Praveen Kumar Rao, Nitin Ramani, Aditya Kale, Shraddha Patkar
International Journal of Gastrointestinal Intervention.2021; 10(4): 196. CrossRef
Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications
Brian M. Fung, Teodor C. Pitea, James H. Tabibian
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Endoscopic management of malignant gastric outlet obstruction
Anish Patel, Amrita Sethi
Techniques and Innovations in Gastrointestinal Endoscopy.2020; 22(4): 220. CrossRef

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Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor: Erkan Caglar, Gulen Doğusoy, Levent Kabasakal, Ahmet Dobrucali; Clin Endosc 2016;49(5):479-482. Published online June 29, 2016; DOI: https://doi.org/10.5946/ce.2015.149

Abstract PDF PubReader ePub: Internal radioembolization with yttrium-90 is a promising treatment method, predominantly for liver tumors. However, the shifting of yttrium-90-loaded spherules into the arteries and veins that supply the duodenum and stomach, leading to ulceration, hemorrhage, perforation, and outlet obstruction of these organs, is one of the major undesirable consequences of this technique. We report a case of gastric outlet obstruction (GOO) due to antropyloric stenosis with ulceration, edema, and inflammation following transarterial yttrium-90 treatment for a metastatic neuroendocrine tumor in a 58-year-old man. Stenting was used for palliation in this case. GOO improved after stenting and recovery of oral intake was permanent after stent removal.

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Systemic Amyloidosis Manifested by Gastric Outlet Obstruction: Sung Woon Park, Hyun Woong Lee, Eun Jung Cho; Clin Endosc 2013;46(5):579-581. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.579

Abstract PDF PubReader ePub

Amyloidosis is characterized by extracellular deposition of insoluble protein fibrils that stain with Congo red application and appear apple green under polarized light. The presenting symptoms result from the involvement of many affected, nonspecific and generalized organ systems. Our patient was an 80-year-old woman with no medical history. She presented with a 2-week history of nausea and vomiting. An esophagogastroduodenoscopy showed erythematous and edematous mucosa on the antrum with pyloric stenosis. Histopathologic examination of the biopsy specimen showed the deposition of amorphous, homogeneous, and acidophilic material in the gastric mucosa. Amyloidal protein was proven by positive Congo red stain. A serum and urine immunfixation electrophoresis showed lambda light chain band. She developed symptoms of repeated greenish color vomiting. A follow-up esophagogastroduodenoscopy showed progressed antral obstruction. However, she refused further evaluation and treatment and was managed conservatively. She later died of disease progression after 34 hospital days.

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A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure
Seonghun Hong, Young-Woon Chang, Jong Kyu Byun, Min Je Kim, Jung Min Chae, Sun Hee Park, Chi Hyuk Oh, Yong-Koo Park
The Korean Journal of Gastroenterology.2015; 66(4): 227. CrossRef

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Self-Expandable Metallic Stent Placement in the Palliative Treatment of Malignant Obstruction of Gastric Outlet and Duodenum: Erkan Çaglar, Ahmet Dobrucali; Clin Endosc 2013;46(1):59-64. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.59

Abstract PDF PubReader ePub

Background/Aims

To asses the usefulness of flexible metallic stents in the palliation of malignant obstruction of gastric outlet and duodenum.

Methods

Retrospective review was performed between January 2006 and December 2011 in 30 patients. Thirty consecutive patients with obstruction of the gastric outlet underwent palliative treatment with self-expandable flexible metallic stents. Complications and clinical outcomes were assessed.

Results

Twenty-four patients had advanced gastric carcinoma at the antrum and/or pylorus, four patients had obstruction at the pylorus due to pancreas tumours and one patient had duodedum and one patient had gall bladder tumour. Symptoms improved in 82.7% of the patients after the procedure. The improvement in ability to eat using the score system was statistically significant (p<0.001). Tumor ingrowth and/or overgrowth were seen in four patients (13.3%), and a second stent was inserted in these patients. The mean stent patency was 100 days (range, 5 to 410). The mean survival was 120.76±38.96 days.

Conclusions

Endoscopic placement of self-expendable metallic stents under fluoroscopy is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach or pancreas cancer.

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Endoscopic Ultrasonography-guided Gastrojejunostomy for Patients with Gastric Outlet Obstruction and Pyloric Metal Stent Dysfunction
Byung Sun Kim, Sung Yeol Yang, Won Dong Lee, Jae Sun Song, Min A Yang, Gum Mo Jung, Jin Woong Cho, Ji Woong Kim
The Korean Journal of Gastroenterology.2022; 79(6): 260. CrossRef
Photodynamic Therapy and Hyperthermia in Combination Treatment—Neglected Forces in the Fight against Cancer
Aleksandra Bienia, Olga Wiecheć-Cudak, Aleksandra Anna Murzyn, Martyna Krzykawska-Serda
Pharmaceutics.2021; 13(8): 1147. CrossRef
Clinical outcomes after multiple self-expandable metallic stent placement using stent-in-stent technique for malignant gastric outlet obstruction
Jin Won Mo, Young Min Kim, Jie-Hyun Kim, Seung Yong Shin, Young Hoon Youn, Hyojin Park
Medicine.2020; 99(21): e19432. CrossRef
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María Carmen Fernández-Moreno, Roberto Martí-Obiol, Fernando López, Joaquín Ortega
Case Reports in Gastroenterology.2017; 11(1): 9. CrossRef
Clinical outcomes of re-stenting in patients with stent malfunction in malignant gastric outlet obstruction
Eun Hyo Jin, Sang Gyun Kim, Ji Yeon Seo, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung
Surgical Endoscopy.2016; 30(4): 1372. CrossRef
Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor
Erkan Caglar, Gulen Doğusoy, Levent Kabasakal, Ahmet Dobrucali
Clinical Endoscopy.2016; 49(5): 479. CrossRef
Efficacy and safety of a partially covered duodenal stent for malignant gastroduodenal obstruction: a pilot study
Dongwook Oh, Sang Soo Lee, Tae Jun Song, Jun-Ho Choi, Do Hyun Park, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim
Gastrointestinal Endoscopy.2015; 82(1): 32. CrossRef
Nausea and vomiting in advanced cancer
Pamela Gordon, Susan B. LeGrand, Declan Walsh
European Journal of Pharmacology.2014; 722: 187. CrossRef

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Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis: Jun Young Lee, Jin Soo Chung, Tae Hyeon Kim; Clin Endosc 2012;45(3):202-204. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.202

Abstract PDF PubReader ePub

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

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A Case of a Removal of Pyloric Stent That Was Partially Embeded in the Mucosa after Temporary Stenting for the Benign Pyloric Stenosis and It Was Removed Using Argon Plasma Coagulation: Joo Yeon Oh, M.D., Jong-Jae Park, M.D., Ja In Park, M.D., Won Woo Lee, M.D., Seung Young Roh, M.D., Hyun-Seok Kang, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2010;40(1):31-35. Published online January 30, 2010

Abstract PDF: Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:31-35)

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The Usefulness of Applying an Additional Clip When Using a Double-layered Pyloric Stent to Treat Gastric Outlet Obstruction: Woo Jin Jung, M.D., Dae Hwan Kang, M.D., Cheol Woong Choi, M.D., Hyung Wook Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Geun Am Song, M.D., Mong Cho, M.D., Kyung Sik Jung, M.D., Yong Wuk Kim, M.D., Dong Uk Kim, M.D., Pyo Jun Kim, M.D. and Il Du Kim, M; Korean J Gastrointest Endosc 2009;38(4):193-198. Published online April 30, 2009

Abstract PDF: Background
/Aims: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. Methods: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. Results: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. Conclusions: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction. (Korean J Gastrointest Endosc 2009;38:193-198)

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The Use of Uncovered Self-Expandable Metallic Stents for Palliation ofGastric Outlet Obstruction Caused by Stomach Cancer: Dae Soon Kwon, M.D., Pyung Gohn Goh, M.D., Se Woong Hwang, M.D., Kwan Woo Nam, M.D., Hee Seok Moon, M.D., Jae Hoon Jung, M.D., Jae Kyu Seong, M.D. and Hyun Yong Jeong, M.D.; Korean J Gastrointest Endosc 2008;36(6):336-340. Published online June 30, 2008

Abstract PDF: Background
/Aims: The purpose of this study is to investigate the effectiveness and safety of the use of uncovered self-expandable metallic stents as a palliative therapy for gastric outlet obstruction caused by stomach cancer. Methods: A total of 36 patients who underwent uncovered stent insertion were investigated. Hanarostents (uncovered pyloric/duodenal stents, M.I. Tech Co., Ltd.) were used in the procedures. The technical success rate, clinical success rate, presence of clinical symptoms and complications were estimated during the study period. Results: The technical success rate for stent replacement was 97.2% (35 out of 36 patients) and the clinical success rate was 91.7% (33 out of 36 patients). The mean dysphagia scores before and after the procedures were 2.44 and 0.92, respectively. The median hospital stay after stenting was 10 days and the mean follow-up period was 91 days. Thirteen patients died during the follow-up period (mean survival, 70 days). The complication rate was 22.2% (8 out of 36 patients). Restenosis occurred in four cases, bleeding in two cases, pain in one case and stent migration in one case. There were no deaths related to the procedures. Conclusions: These findings suggest that placement of uncovered self-expandable metallic stents for gastric outlet obstruction caused by stomach cancer results in good symptomatic improvement with a low rate of complications. (Korean J Gastrointest Endosc 2008;36:336-340)

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Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer: Hyoung Yoel Park, M.D., Dae Hwan Kang, M.D., Jae Sup Eum, M.D., Tae In Ha, M.D., Chan Ho Park, M.D., Kyung Yeob Kim, M.D., Cheol Woong Choi, M.D., Do Hoon Kim, M.D., Ji Young Kim, M.D., Hye Jeong Lee, M.D., Gwang Ha Kim, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2008;36(2):57-63. Published online February 27, 2008

Abstract PDF: Background
/Aims: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. Methods: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. Results: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p＜0.05). Conclusions: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer. (Korean J Gastrointest Endosc 2008;36:57-63)

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Treatment of Gastric Outlet Obstruction by Stomach Cancer with using Double-layered Pyloric Stent: Soo Hyoung Lee, M.D., Dae Hwan Kang, M.D.*, Yong Mock Bae, M.D., Cheul Woong Choi, M.D.*, Tai In Ha, M.D.*, Chan Ho Park, M.D.*, Hyoung Yoel Park, M.D.*, Sun Mi Lee, M.D.*, Gwang Ha Kim, M.D.* and Geun Am Song, M.D.*; Korean J Gastrointest Endosc 2007;35(4):221-227. Published online October 30, 2007

Abstract PDF: Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. Methods: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. Results: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. Conclusions: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent. (Korean J Gastrointest Endosc 2007;35:221-227)

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A Case of Aggravated Esophageal Candidiasis and Gastric Yeast Bezoar Formation following Gastric Outlet Obstruction due to Duodenal Stenosis: Jung Hoon Song, M.D., Eun Bin Lee, M.D., Nam Seon Park, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D., Kyu Chel Lee, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(4):205-209. Published online April 30, 2007

Abstract PDF: Esophageal candidiasis is the most common disease among all candida infections of the gastrointestinal tract, and generally develops in immunocompromised patients. The prevalence of esophageal candidiasis has increased in patients undergoing antibiotic therapy, diabetes, adrenal dysfunction, alcohol intoxication, old age, esophageal injury, esophageal stasis, gastric surgery, and acid suppressive therapy. However, the overall prevalence is not higher than that of immunocompromised patients. Gastric candidiasis is uncommon because of the strong acidity of the gastric juices. The most common clinical setting for gastric candidiasis is in patients with neoplastic disease. However, there are some case reports suggesting an increase in the prevalence of gastric candidiasis after gastric ulcer therapy with surgery or acid suppressive agents. Delayed gastric emptying, increased intragastric pH, and reflux of the duodenal contents into the stomach are factors indicative of the pathophysiology of gastric candidiasis after gastric surgery. We encountered a case of aggravated esophageal candidiasis and the formation of a gastric yeast bezoar following a gastric outlet obstruction due to a duodenal stenosis. We herein report this case along with an overview of the relevant literature. (Korean J Gastrointest Endosc 2007;34:205⁣209)

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Migration of Pyloric Self-Expanding Metallic Stent to the Esophagus: Young Gyun Kim, M.D., Jun Pyo Chung, M.D., Seung Hyun Cho, M.D., Seoung Joon Hwang, M.D., Dok Yong Lee, M.D., Sang Won Ji, M.D., Yong-Han Paik, M.D., Se Joon Lee, M.D., Byung Soo Moon, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Jin Kyung Kang, M.D.; Korean J Gastrointest Endosc 2003;27(2):80-83. Published online August 30, 2003

Abstract PDF: Self-expandable metallic stent (SEMS) has been reported to provide effective treatment alternatives with minimal morbidity for patients with malignant gastroduodenal obstruction. Limitations of SEMSs are stent occlusion due to tumor ingrowth or overgrowth and stent migration. Migrated stents may remain in the stomach or travel distally. To our knowledge, however, migration of pyloric SEMS to the esophagus has not been reported. We experienced such a case in a 65-year-old woman who had undergone a gastrojejunostomy and choledochojejunostomy due to unresectable pancreatic head cancer. Pyloric SEMSs (Niti-S Pyloric Bare Stent, 18⁓60 mm, Taewoong Medical, Korea) were deployed at the obstructed efferent and afferent loops. After severe vomiting, a pyloric SEMS placed at the afferent loop migrated into the esophagus, which caused severe chest pain and intractable hiccup. It was removed endoscopically. This case illustrates that pyloric SEMS can migrate to the esophagus through the lower esophageal sphincter. (Korean J Gastrointest Endosc 2003;27:80⁣83)

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Palliative Self-expandable Metal Stents for Malignant Gastric Outlet Obstruction: Bo Suk Kim, M.D., Jae Hyeon Moon, M.D., Dae Sik Kwon, M.D., Jin Kwang An, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2003;26(3):119-124. Published online March 31, 2003

Abstract PDF: Background
/Aim: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. Methods: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis^ⰒTaewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. Results: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1∼9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). Conclusions: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method. (Korean J Gastrointest Endosc 2003;26:119⁣124)

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간헐적 위출구 폐쇄를 유발한 위용종 3 예 ( Three Cases of Gastric Polyps Producing Intermittent Gastric Outlet Obstruction ): Korean J Gastrointest Endosc 2001;23(3):179-183. Published online November 30, 2000

Abstract PDF: The manifestations of gastric polyps vary, including abdominal pain, nausea, and vomiting or gastrointestinal bleeding. Sometimes large polyp of the stomach causes intermittent outlet obstruction. Most of gastric polyps that prolapse through the pylorus are peduculated adenomatous polyps located in the antral and prepyloric regions. Even though the polyps has no evidence of malignancy, the polyps producing pyloric obstruction should be removed by polypectomy or surgery. Herein we describe 3 cases of a large, benign, and pedunculated gastric polyp that led to intermittent gastric outlet obstruction with review of literatures. (Korean J Gastroites Endosc 2001;23:179-183)

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악성 위출구 협착에서의 경구적 자가확작형 금속제 인공관 유치의 유용성 - 경내시경적 인공관을 중심으로 - ( Palliation of Unresectable Gastric Outlet Obstruction with Self-Expandable Metal Stent ): Korean J Gastrointest Endosc 2000;21(1):509-517. Published online November 30, 1999

Abstract PDF: Background
/Aims : Placement of stents in cases of inoperable malignant gastric outlet obstruction is difficult due to anatomical and technical problems. The aim of this study was to assess the feasibility, effectiveness, safety, and long-term outcome of a self-expandable metal stent (SEMS) as a means of providing palliative care for patients with an inoperable malignant gastric outlet obstruction, Methods : Fifty-one consecutive patients (53 cases of stent insertion) with onoperable gastric outlet obstruction were treated palliatively with EsophaCoil, Choo's stent, or through-the-scope (TTS) stent. Results : Technical Success was achieved in 46 cases (86.8%). Six cases of stent insertion failure were caused by acute angulation of the stenotic area and sereve distal luminal narrowing. The other failed case was due to the inappropriate location of the stent. In 41 cases, the patients (89.1%) could ingest soft or solid foods after successful insertion of the stents. All the remaining 16 cases of TTS SEMS had technical and clinical successes. During the follow-up (mean; 3.3±1.1 months, range; 1∼11 months), there was 1case of aspiration pneumonia, 1 case of bowel perforation, 2 cases of stent migration, and 2 cases of stent occlusion by tumor ingrowth. Conclusions ; Placement of a SEMS, especially TTS SEMS in patients with malignant gastric outlet obstruction is a feasible, effective, and safe palliative therapy. (Korean J Gastrointest Endosc 2000; 21:509-517)

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유문륜으로 탈출된 과오종성 위 용종 1예 ( A Case of Gastric Hamartoma Prolapsing Through the Pylorus ): Korean J Gastrointest Endosc 1999;19(6):941-944. Published online November 30, 1998

Abstract PDF: Gastric hamartoma is usually an asymptomatic, small, sessile polyp, located in the body and fundus of the stomach. A case was experienced involving a solitary large hamartomatous polyp prolapsing through the pylorus in a 63-year old female presented with melena. A gastroendoscopy determined a pedunculated gastric polyp prolapsing through the pylorus with fresh blood oozing and congestion. A UGI series revealed that a 5 cm sized lobulated mass with a long stalk attached at the greater curvature side of the fundus. The polyp was removed by an endoscopic snare polypectomy and diagnosed as a gastric hamartoma. (Korean J Gastrointest Endosc 19: 941∼944, 1999)

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