title: Preliminary study of enteroscopy-guided, self-expandable metal stent placement for malignant small bowel obstruction.
abstract: OBJECTIVE
  Technical limitations of conventional endoscopes and delivery systems frequently hamper palliative endoscopic placement of self-expandable metal stents for malignant small bowel obstruction. This study examined feasibility of the double balloon enteroscope-guided withdrawal-reinsertion method as a rescue procedure in patients with failed palliative stent placement for malignant small bowel obstruction.
  
  
  METHODS
  We enrolled 19 consecutive patients with small bowel obstruction due to metastatic gastric (n = 15) or colorectal cancer (n = 2), or primary small bowel carcinoma (n = 2), in whom previous attempts to place self-expandable metal stents using conventional endoscopy had failed. Ten patients had undergone previous gastric surgery. After passing a guide-wire using an enteroscope with or without the double-balloon method, the enteroscope was withdrawn. A conventional endoscope was re-inserted along the guide-wire, and through-the-scope self-expandable metal stent placement was performed.
  
  
  RESULTS
  Obstruction sites were efferent jejunal loop, proximal jejunum, and third duodenal portion. Technical success was achieved with 94.7% (18/19) of stents, and clinical success occurred with 84.2% (16/19) of patients. The gastric outlet obstruction score (pre-procedure: 0.68 ± 0.58) increased by one week (2.05 ± 0.52, P < 0.001). Stent migration and restenosis occurred in two (10.5%) and four (21.1%) of 19 stents, respectively. Median stent patency duration was 67 days and median survival was 93 days; these did not differ significantly by palliative chemotherapy (P = 0.76 and 0.67, respectively).
  
  
  CONCLUSIONS
  The double-balloon enteroscopy-guided method followed by conventional endoscopic self-expandable metal stent delivery was effective for rescue palliation of malignant small bowel obstruction.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000368:Aged; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects / Q000379:methods*; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007579:Jejunal Diseases / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications; D016896:Treatment Outcome
chemical_list: D008670:Metals