Endoscopy 2020; 52(03): 232-233
DOI: 10.1055/a-1015-6423
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How to modify the axis of a self-expandable metal stent to avoid malfunction in gastric outlet obstruction: a simple trick

Benedetto Mangiavillano
1   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
2   Humanitas University, Milan, Italy
,
Francesco Auriemma
1   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Mario Bianchetti
1   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Alessandro Repici
2   Humanitas University, Milan, Italy
3   Digestive Endoscopy Unit, Istituto Clinico Humanitas Research Hospital, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
08 October 2019 (online)

Malignant gastric outlet obstruction (GOO) is caused mainly by gastric or pancreaticobiliary neoplasms. GOO presents with uncomfortable symptoms, such as nausea, vomiting, and abdominal distension, leading to malnutrition and impaired quality of life [1] [2]. Endoscopic placement of a self‐expandable metal stent (SEMS) is widely accepted as nonsurgical palliative treatment of nonresectable malignant GOO [3]. However, the efficacy of the SEMS can be compromised, especially in patients affected by gastric antral neoplasia, in which GOO relief is not completely obtained. One of the reasons why gastric SEMS can be ineffective is possibly due to the impact of the proximal end of the stent at the great curvature of the gastric body ([Fig. 1 a]).

Zoom Image
Fig. 1 Axis of a self-expandable metal stent after its deployment. a Before modification. b After modification by a standard clip.

Four patients who were unfit for surgery underwent SEMS placement for malignant GOO (three women: 25, 52, and 56 years old; and one 57-year-old man). With a standard clip we caught the proximal end of the stent, closing the clip inside the mesh of the body of the SEMS ([Video 1]). This trick modifies the proximal axis of the stent ([Fig. 1 b]), restoring the normal anatomy of the stomach ([Fig. 2]).

Video 1 Modification of the axis of a self-expandable metal stent to avoid malfunction in gastric outlet obstruction.


Quality:
Zoom Image
Fig. 2 X-ray images. a Proximal part of the self-expandable metal stent (SEMS) with the modified axis. b Correct progression of the contrast medium after SEMS modification.

This treatment aims to avoid malfunction of the SEMS by using the clip to modify the axis of the stent and restore the normal anatomy of the stomach.

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  • References

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