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Benign obstruction of the colon
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Diverticular disease as a cause of acute large bowel obstruction is uncommon and is usually secondary to acute diverticulitis or acute-on-chronic inflammation of a diverticular segment. It is difficult to differentiate it from malignant disease either before or at the time of operation, but water-soluble barium enema or endoscopy with biopsy or brush cytology should be performed to try and achieve a diagnosis before any planned surgery. Decompression of the obstructed colon remains the first priority and, while a proximal diverting colostomy (often performed laparoscopically) with minimal morbidity is frequently advocated, endoscopic decompression has now become an option. Colonoscopic decompression entails passing an expandable metallic (or other) stent over a guidewire, which is manoeuvred through the stricture, preferably under fluoroscopic control. An unprepared water-soluble contrast enema is performed and a guidewire is then manipulated across the stricture. This may be achieved simply using an angiographic catheter under fluoroscopic control or, in patients with more proximal lesions, an endoscope is used to guide the wire across the lesion. The catheter is then exchanged for a self-expandable metallic stent, which is thus deployed across the stricture, and the guidewire withdrawn (Fig. 14.6).
Esophageal stents
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Nabil P. Rizk, Sarah K. Thompson
An increasing incidence of esophageal cancer in the Western hemisphere is occurring without a concomitant increase in the rate of early detection. Consequently, the number of patients presenting with advanced stage disease (not appropriate for surgery or irradiation) is increasing at an alarming rate, and the need to provide these patients with obstruction (a). A self-expandable metallic stent (SEMS) has been inserted to open up the lumen of the esophagus before initiation of chemoradiotherapy (b). palliative treatment options to maintain their quality of life is increasingly relevant. Among the most debilitating symptoms in patients with advanced stage esophageal cancer is dysphagia. Advancements in stent technology during the past two decades have dramatically improved the management of this condition, by far the most common indication for the placement of an esophageal stent. Unlike for other indications, the goal of treatment of malignant strictures and obstruction from tumor encroachment is to durably improve dysphagia while minimizing the risks of the intervention and the need for reinterventions. Overall, when SEMS are used to palliate malignant esophageal obstruction, they are cost-effective, efficient, and successful at palliating patients (see Figure 28.1).
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
73 Dutau H, Breen DP, Gomez C, Thomas PA, Vergnon JM. The integrated place of tracheobronchial stents in the multidisciplinary management of large post-pneumonectomy fistulas: Our experience using a novel customised conical self-expandable metallic stent. Eur J Cardiothorac Surg. 2011;39(2): 185-189.
Analysis of prognostic factors in patients with self-expandable metallic stents for treatment of malignant gastric outlet obstruction
Published in Scandinavian Journal of Gastroenterology, 2023
Yoshiko Nakano, Yoshinori Mizumoto, Bunji Endoh, Tsubasa Shimogama, Satoru Iwamoto, Naoki Esaka, Yoshiyuki Ohta, Katsuyuki Murai, Masaki Murata, Shin’ichi Miyamoto
Malignant gastric outlet obstruction (GOO) is defined as the mechanical obstruction of the pylorus or duodenum secondary to advanced malignancies, such as gastric cancer, pancreatic cancer and metastasis of other cancers [1,2]. It makes oral intake difficult or even impossible and consequently causes nausea, vomiting and abdominal distension, leading to malnutrition and compromised quality of life [3]. Self-expandable metallic stent (SEMS) is reported to be effective for malignant GOO as a less-invasive palliative treatment compared with gastrojejunostomy [4,5], and it is widely accepted worldwide. SEMS is recommended for patients with malignant GOO who have a life expectancy of <2–3 months because this is the approximate duration of time after which stent dysfunction occurs [6,7]. However, endoscopic reinterventions enable oral intake, and the time from the procedure to the resumption of food intake and hospital stay are reported to be shorter in the SEMS group than in the gastrojejunostomy group [4,6]. These findings suggest the possibility that patients who undergo SEMS placement can receive chemotherapy earlier than those who undergo gastrojejunostomy. Moreover, Kobayashi et al. and Azemoto et al. reported that duodenal SEMS for patients with pancreatic cancer and GOO was advantageous in terms of its safety and smooth administration of the following chemotherapy regimens compared with gastrojejunostomy [8,9].
Inutility of endoscopic sphincterotomy to prevent pancreatitis after biliary metal stent placement in the patients without pancreatic duct obstruction
Published in Scandinavian Journal of Gastroenterology, 2020
Shin Kato, Masaki Kuwatani, Tsuyoshi Hayashi, Kazunori Eto, Michihiro Ono, Nobuyuki Ehira, Hiroaki Yamato, Itsuki Sano, Yoko Taya, Manabu Onodera, Kimitoshi Kubo, Hideyuki Ihara, Hajime Yamazaki, Naoya Sakamoto
A duodenoscope (TJF260V, JF260V, or TJF240: Olympus Medical Systems, Tokyo, Japan) was inserted into the second portion of the duodenum under conscious sedation using an analgesic agent (fentanyl or pethidine) and a sedative agent (midazolam or diazepam). Bile duct cannulation was attempted using a wire-guided cannulation method; however, for cases in which selective cannulation for the bile duct was difficult, contrast medium infusion was performed and/or a double guidewire was used. After selective bile duct cannulation, the location of the stricture was confirmed using a cholangiogram with contrast medium. ES was performed for 82 patients in the ES group by a standardized technique (cutting above the hooding hold) using a sphincterotome (CleverCut3V: Olympus Medical Systems, Tokyo, Japan or AutotomeTM RX: Boston Scientific Japan, Tokyo, Japan). ES was not performed for the remaining 78 patients. The performance of ES was at the discretion of the endoscopist. A self-expandable metallic stent (SEMS) was inserted through the bile duct stricture and deployed under fluoroscopy.
Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility
Published in Acta Chirurgica Belgica, 2023
Reza Chinikar, Daniel Patricio, Juliette Gosse, Brigitte Ickx, Myriam Delhaye, Jean Closset, Imad El Moussaoui, Maya Hites, Julie Navez
Among the 75 patients who underwent PBD with stenting, 44 (59%) had a self-expandable metallic stent and 31 (41%) one or more plastic stent(s). The median duration between PBD and the PD was 29 (20 − 49) days in patients without neoadjuvant treatment and 196 [147 − 225) days in patients undergoing neoadjuvant therapy. Twenty-two (29%) PBD + patients had a bile sample during the endoscopic procedure, and 16 (21%) had a positive bile culture. Some cultures identified multiple germs at bacteriological examination, the most frequent was Escherichia Coli (n = 7).