Clinical Endoscopy

Original Article

Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study: Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka; Clin Endosc 2024;57(5):628-636. Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.155

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a gastric outlet obstruction scoring system score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips

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

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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.

Citations

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Hyuk Lee, Kenneth Hyunsoo Park, Ulysses Rosas, Mohamad Othman El Helou, Jae Min Lee, Liliana Bancila, Laith H Jamil, Quin Liu, Rabindra R. Watson, Srinivas Gaddam, Simon K Lo
Endoscopy International Open.2024;[Epub] CrossRef
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Takashi Sasaki, Tsuyoshi Takeda, Yuto Yamada, Takeshi Okamoto, Chinatsu Mori, Takafumi Mie, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
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Michiel Bronswijk, Enrique Pérez‐Cuadrado‐Robles, Schalk Van der Merwe
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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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Review

Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions: Hao Chi Zhang, Monica Tamil, Keshav Kukreja, Shashideep Singhal; Clin Endosc 2020;53(2):167-175. Published online August 13, 2019; DOI: https://doi.org/10.5946/ce.2019.050

Abstract PDF PubReader ePub

Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies.

Citations

Citations to this article as recorded by

Endoscopic Management of Malignant Biliary Obstruction
Woo Hyun Paik, Do Hyun Park
Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 127. 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
A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies
Giacomo Emanuele Maria Rizzo, Lucio Carrozza, Dario Quintini, Dario Ligresti, Mario Traina, Ilaria Tarantino
Cancers.2023; 15(9): 2585. CrossRef
EUS-guided gallbladder drainage using a lumen-apposing metal stent as rescue treatment for malignant distal biliary obstruction: a large multicenter experience
Cecilia Binda, Andrea Anderloni, Alessandro Fugazza, Arnaldo Amato, Germana de Nucci, Alessandro Redaelli, Roberto Di Mitri, Luigi Cugia, Valeria Pollino, Raffaele Macchiarelli, Benedetto Mangiavillano, Edoardo Forti, Mario Luciano Brancaccio, Roberta Bad
Gastrointestinal Endoscopy.2023; 98(5): 765. CrossRef
Choledochoduodenostomy Versus Hepaticogastrostomy in Endoscopic Ultrasound-guided Drainage for Malignant Biliary Obstruction: A Meta-analysis and Systematic Review
Kejie Mao, Binbin Hu, Feng Sun, Kaiming Wan
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2022; 32(1): 124. 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

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Case Reports

Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report: Jung Won Chun, Sang Hyub Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim; Clin Endosc 2019;52(5):510-515. Published online July 4, 2019; DOI: https://doi.org/10.5946/ce.2018.191

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The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

Citations

Citations to this article as recorded by

Benign Duodenal Stricture Treated with Surgical Correction and Dietary Therapy in a Golden Retriever
John C. Rowe, Alice A. Huang, Jin Heo, Nolie K. Parnell, Adam J. Rudinsky
Case Reports in Veterinary Medicine.2020; 2020: 1. CrossRef
Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms
Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng
World Journal of Gastroenterology.2020; 26(23): 3213. CrossRef

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Endoscopic Diagnosis of Duodenal Stenosis in a 5-Month-Old Male Infant: Maribeth R. Nicholson, Sari A. Acra, Dai H. Chung, Michael J. Rosen; Clin Endosc 2014;47(6):568-570. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.568

Abstract PDF PubReader ePub

Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion.

Citations

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Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm
Song Sun, Shan Zheng, Jie Wu, Zifei Tang, Chun Shen, Gong Chen, Kuiran Dong
Frontiers in Pediatrics.2024;[Epub] CrossRef
Thirty‐two‐month‐old with multiple duodenal webs diagnosed after failed gastrojejunostomy exchange successfully treated with combination endoscopic therapy
Naomi E. B. Tjaden, Michael Acord, Jane Minturn, Myron Allukian, Petar Mamula
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Successful treatment with endoscopic radial incision for congenital duodenal membranous stenosis in three children
Yun-Ping Tang, Xu-Xia Wei, Xiao-Li Fu, Ning Xue, Jun-Jie Xu
Journal of Pediatric Surgery Case Reports.2021; 74: 102043. CrossRef
Robotic duodeno-duodenostomy creation in a pediatric patient with idiopathic duodenal stricture
Andrea R. Marcadis, Carmelle V. Romain, Fuad Alkhoury
Journal of Robotic Surgery.2019; 13(5): 695. CrossRef
Hematemesis in a 5-Month-Old Girl: A Tale of Double Whammy
Dustin Gulizia, Nujeen Zibari, Monaliza Evangelista
Clinical Pediatrics.2018; 57(5): 615. CrossRef
Detection of an Infant’s Duodenal Atresia by Milk Scan
Ha Wu, Zhiheng Huang, Min Ji, Yiwei Li, Ruifang Zhao
Clinical Nuclear Medicine.2017; 42(2): 140. CrossRef
Small Bowel Congenital Anomalies: a Review and Update
Grant Morris, Alfred Kennedy, William Cochran
Current Gastroenterology Reports.2016;[Epub] CrossRef
Gastrointestinal endoscopic practice in infants: Indications and outcome
Nagla H. Abu Faddan, Almoutaz Eltayeb, Maha Barakat, Yasser Gamal
Egyptian Pediatric Association Gazette.2016; 64(4): 160. CrossRef
Clinical Practice Guidelines for the Management of Gastroesophageal Reflux and Gastroesophageal Reflux Disease: Birth to 1 Year of Age
Michelle M. Papachrisanthou, Renée L. Davis
Journal of Pediatric Health Care.2015; 29(6): 558. CrossRef

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Partial Duodenal Obstruction Caused by an Impacted Gastritis Cystica Polyposa: Ju Hwan Kim, M.D., Chang Il Kwon, M.D., Seung Won Koo, M.D., Kwang Ho Yoo, M.D., Gwang Il Kim, M.D.*, So Young Chong, M.D., Kwang Hyun Ko, M.D. and Sung Pyo Hong, M.D.; Korean J Gastrointest Endosc 2010;41(4):228-231. Published online October 30, 2010

Abstract PDF: Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the non-operated stomach. This malady is characterized by polypoid mucosal changes with hyperplasia and cystic dilatation of glands that infiltrate into the submucosal layer. We report here on a case of gastritis cystica polyposa that presented as a mass impacted in the duodenum in a 63-year-old male, and this patient had been admitted for evaluation of progressive epigastric fullness and dyspepsia. Esophagogastroduodenoscopy revealed that the partial duodenal obstruction was caused by impaction of a huge polypoid mass with a stalk that originated from the lower body of the stomach. We fished out the impacted mass with a forceps catheter while holding the neck with a snare catheter. Thereafter, an endoloop was applied to the stalk of mass, and this was followed by polypectomy using a snare catheter. (Korean J Gastrointest Endosc 2010;41:228-231)

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A Case of Duodenal Obstruction Induced by the Short-term Use of a Nonsteroidal Anti-inflammatory Drug: Ji Hyun Song, M.D., Ki Nam Shim, M.D., Hyun Joo Song, M.D., Hee Jung Oh, M.D., Kum Hei Ryu, M.D., Hye Jung Yeom, M.D., Seong-Eun Kim, M.D., Tae Hun Kim, M.D., Hye Kyung Jung, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D. and Il Hwan Moon, M.D.; Korean J Gastrointest Endosc 2006;32(4):278-282. Published online April 30, 2006

Abstract PDF: Giant duodenal ulcer can be defined as a variant of peptic ulceration that exceeds 2 cm at the greatest diameter. The high mortality and morbidity of giant duodenal ulcer are directly related to the resultant perforation, obstruction and massive hemorrhage. The patient usually has a long history of an inadequately treated or neglected peptic ulcer, but this malady is rarely induced by nonsteroidal anti- inflammatory drugs (NSAIDs). A 60-year-old man was referred to us due to epigastric pain. He underwent appendectomy 1 week ago, and he was administered ketorolac (tarasyn^Ⱂ) for 5 days to control the postoperative pain. Esophagogastroduodenos copy (EGD) revealed a giant duodenal ulcer encircling the lumen from the pylorus to the postbulbar portion of the duodenum, and he was then treated with proton pump inhibitor. Two weeks later, the follow-up EGD showed complete duodenal obstruction at the bulb. He was treated by laparoscopic gastrojejunostomy. We report here on this case of duodenal obstruction that was induced by the short-term use of NSAIDs. (Korean J Gastrointest Endosc 2006;32:278⁣282)

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A Case of Obstructive Jaundice after Insertion of Metallic Stent for Duodenal Obstruction: Jin Kwang Lee, M.D., Sang Jong Park, M.D., Kwang Hyun Ryu, M.D., Sang Bae Lee, M.D.,; Korean J Gastrointest Endosc 2004;28(4):213-218. Published online April 30, 2004

Abstract PDF: Insertion of self-expandable metallic stent has been performed as a palliative therapeutic modality for cases with gastrointestinal obstruction caused by inoperable malignancies such as pancreatic cancer, stomach cancer, and cholangiocarcinoma. Although the clinical efficacy is not established yet, it can also be performed for benign gastroduodenal obstruction. Especially, when balloon dilatation is failed and patients are at high risk for surgery or general anesthesia, and when patients refuse operation, insertion of metallic stent can be considered. Complications of this therapeutic modality include intestinal perforation, hemorrhage, migration or malposition of metallic stent, and occlusion of stent by ingrowth and overgrowth of tumor or impaction of food. We report a rare case of obstructive jaundice developed after the insertion of gastroduodenal stent for duodenal obstruction caused by recurrent duodenal ulcer. (Korean J Gastrointest Endosc 2004;28:213 ⁣217)

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유두부주위암에 의한 악성 십이지장 폐쇄환자에서의 자가팽창형 금속인공관 삽입치료: Korean J Gastrointest Endosc 2003;27(5):379-379. Published online November 20, 2003

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증례 : 식욕과항진으로 오진된 소아 십이지장 격막 1예 ( Case Reports : A Case Report of Duodenal Diaphragm Misdiagnosed as a Bulimia ): Korean J Gastrointest Endosc 1995;15(3):545-551. Published online November 30, 1994

Abstract PDF: Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.

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