Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction

Suzanne M. Jeurnink, Alessandro Repici, Carmelo Luigiano, Nico Pagano, Ernst J. Kuipers, Peter D. Siersema

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Stent placement in the distal duodenum or proximal jejunum with a therapeutic gastroscope can be difficult, because of the reach of the endoscope, loop formation in the stomach, and flexibility of the gastroscope. The use of a colonoscope may overcome these problems. Objective: To report our experience with distal duodenal stent placement in 16 patients using a colonoscope. Methods: Multicenter, retrospective series of patients with a malignant obstruction at the level of the distal duodenum and proximal jejunum and treated by stent placement using a colonoscope. Main outcome measurements are technical success, ability to eat, complications, and survival. Results: Stent placement was technically feasible in 93% (15/16) of patients. Food intake improved from a median gastric outlet obstruction scoring system (GOOSS) score of 1 (no oral intake) to 3 (soft solids) (p = 0.001). Severe complications were not observed. One patient had persistent obstructive symptoms presumably due to motility problems. Recurrent obstructive symptoms were caused by tissue/tumor ingrowth through the stent mesh [n = 6 (38%)] and stent occlusion by debris [n = 1 (6%)]. Reinterventions included additional stent placement [n = 5 (31%)], gastrojejunostomy [n = 2 (12%)], and endoscopic stent cleansing [n = 1 (6%)]. Median survival was 153 days. Conclusion: Duodenal stent placement can effectively and safely be performed using a colonoscope in patients with an obstruction at the level of the distal duodenum or proximal jejunum. A colonoscope has the advantage that it is long enough and offers good endoscopic stiffness, which avoids looping in the stomach.

Original languageEnglish
Pages (from-to)562-567
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume23
Issue number3
DOIs
Publication statusPublished - Mar 2009

Keywords

  • G-I < endoscopy, technical < endoscopy
  • GI < cancer
  • Therapeutic/palliation < endoscopy

ASJC Scopus subject areas

  • Surgery

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