title: Use of a colonoscope for distal duodenal stent placement in patients with malignant obstruction.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. s.jeurnink@erasmusmc.nl
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Jeurnink
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020685:Colonoscopes; D004386:Duodenum; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome