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Title: A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis

Abstract

PurposeTo evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis.MethodsFrom March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated.ResultsTechnical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days.ConclusionsThe newly designed stent is associated with a high degree of technical successmore » and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.« less

Authors:
; ; ; ; ; ;  [1]
  1. The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology (China)
Publication Date:
OSTI Identifier:
22470101
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 1; Conference: IROS 2015: Interventional Radiological Olbert Symposium, Berlin (Germany), 15-17 Jan 2015; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; DIET; LAYERS; PANCREAS; PATIENTS; SARCOMAS; SYMPTOMS

Citation Formats

Zhou, Wei-Zhong, E-mail: xmjbq007@163.com, Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com, Liu, Sheng, E-mail: liusheng1137@sina.com, Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com, Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com, Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com, and Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn. A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis. United States: N. p., 2015. Web. doi:10.1007/S00270-014-0899-9.
Zhou, Wei-Zhong, E-mail: xmjbq007@163.com, Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com, Liu, Sheng, E-mail: liusheng1137@sina.com, Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com, Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com, Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com, & Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn. A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis. United States. doi:10.1007/S00270-014-0899-9.
Zhou, Wei-Zhong, E-mail: xmjbq007@163.com, Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com, Liu, Sheng, E-mail: liusheng1137@sina.com, Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com, Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com, Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com, and Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn. Sun . "A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis". United States. doi:10.1007/S00270-014-0899-9.
@article{osti_22470101,
title = {A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis},
author = {Zhou, Wei-Zhong, E-mail: xmjbq007@163.com and Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com and Liu, Sheng, E-mail: liusheng1137@sina.com and Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com and Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com and Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com and Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn},
abstractNote = {PurposeTo evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis.MethodsFrom March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated.ResultsTechnical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days.ConclusionsThe newly designed stent is associated with a high degree of technical success and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.},
doi = {10.1007/S00270-014-0899-9},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 38,
place = {United States},
year = {Sun Feb 15 00:00:00 EST 2015},
month = {Sun Feb 15 00:00:00 EST 2015}
}
  • Purpose: To assess the use of self-expanding metallic stents in patients with inoperable malignant antrum-pylorus-duodenal obstruction. Methods: Six patients underwent implantation of a Wallstent self-expanding metallic endoprosthesis (20 mm in five patients and 16 mm in one). In five patients a catheter (Berenstein) was introduced perorally into the stomach. A guidewire (Terumo) was introduced through the catheter and advanced through the antrum-pylorus-duodenal stenosis. The guidewire was removed and a 260-cm-long, 0.035'' superstiff guide (Amplatz) was introduced. After the catheter was removed the stent assembly was introduced. In the last patient the stent was implanted through a percutaneous gastrostomy. Results: Treatmentmore » of inoperable gastric outlet obstruction caused by tumor compression is difficult and unsatisfactory. Peroral implantation of self-expanding metallic stents resulted in successful palliative therapy of antrum-pylorus-duodenal stenosis in six patients in whom surgery was not possible because of advanced disease and poor general condition. On average, patients were able to eat during 41 days. One patient is tolerating oral intake at 3 months. Conclusion: Implantation of stents resulted in palliative relief of malignant antrum-pylorus-duodenal obstructions.« less
  • PurposeTo evaluate the technical feasibility and clinical efficacy of placement of a newly designed Y-shaped branched covered stent for palliative treatment of malignant hilar biliary obstruction.MethodsFrom June 2011 to September 2014, 34 consecutive patients with malignant hilar biliary obstruction underwent percutaneous placement of a Y-shaped branched covered stent for palliative treatment. Technical and clinical success, complications, cumulative patient survival, and stent patency were evaluated.ResultsStent placement was technically successful in all patients. All patients showed adequate biliary drainage on the follow-up cholangiogram. Mean serum bilirubin level (10.9 mg/dl) decreased significantly 1 week (5.7 mg/dl) and 1 month (2.6 mg/dl) after stent placement (p < 0.01). Complications associated withmore » the procedure included hemobilia (n = 3) and biloma (n = 1). During the mean follow-up period of 225 (range 12–820) days, nine patients (26.5 %) developed stent occlusion caused by tumor overgrowth (n = 8) and sludge (n = 1). Two of them underwent coaxial placement of a second stent with good results. The median survival time was 281 days and median primary stent patency was 337 days. There were no significant differences in the patient survival and stent patency rates in relation to age, sex, or Bismuth type.ConclusionPercutaneous placement of the Y-shaped branched covered stent seems to be technically feasible and clinically effective for palliative treatment of malignant hilar biliary obstruction.« less
  • Purpose: To describe our experience using the Gianturco Z-stent (G-Z stent) for the management of malignant tracheobronchial stenosis, with special reference to complications. Methods: Thirty-six stents were used in 22 patients with 28 lesions. Thirteen patients were grade 5 according to the Hugh-Jones classification. The technical success rates, follow-up results, and complications were reviewed on the basis of the patients' charts and radiographs. Results: All stents were successfully placed in the ideal position without procedure-related complications. After the procedure, respiratory status improved in 95% (21/22) of patients, and performance status improved in 77% (17/22). Mean survival after stent placement wasmore » 15 weeks. Four patients suffered from increased thick secretions requiring multiple suctioning and aspiration by bronchoscopy. One of these patients died from asphyxiation 2 weeks after placement. Stent disruption and/or migration was observed in six patients. Of these six, four experienced life-threatening hemoptysis; all four had received aggressive anticancer treatment. Conclusion: G-Z stents are useful for palliation of malignant tracheobronchial obstruction. However, complications of stent strut fracture and migration give cause for concern.« less
  • We present a patient with disseminated stomach cancer who presented with symptoms of acute obstruction of the splenic flexure of the colon caused by tumor spread. During a first attempt to insert a colon stent through the anus under endoscopic guidance as final palliative therapy, it was not possible to reach the region of the stricture, and iatrogenic perforation of the descending colon occurred, which resolved favorably under conservative management. A second attempt to insert a stent was made via percutaneous puncture of the transverse colon, approaching the region of the stricture by a descending route. The procedure was completedmore » without complications and the patient's symptoms improved. Stent placement via percutaneous puncture of the colon has not previously been described in the literature. It may be an alternate route in cases of proximal strictures in which access through the anus has been unsuccessful even with the aid of endoscopic guidance.« less
  • We present a patient with disseminated stomach cancer who presented with symptoms of acute obstruction of the splenic flexure of the colon caused by tumor spread. During a first attempt to insert a colon stent through the anus under endoscopic guidance as final palliative therapy, it was not possible to reach the region of the stricture, and iatrogenic perforation of the descending colon occurred, which resolved favorably under conservative management. A second attempt to insert a stent was made via percutaneous puncture of the transverse colon, approaching the region of the stricture by a descending route. The procedure was completedmore » without complications and the patient's symptoms improved. Stent placement via percutaneous puncture of the colon has not previously been described in the literature. It may be an alternate route in cases of proximal strictures in which access through the anus has been unsuccessful even with the aid of endoscopic guidance.« less