title: [Stent placement using a double-balloon endoscope for malignant duodenal obstruction with Roux-en-Y Anastomosis-a case report].
abstract: A 79-year-old man who had previously undergone partial resection of the remnant stomach and Roux-en-Y reconstruction was diagnosed as having peritoneal recurrence near the ligament of Treitz. In the course of chemotherapy for recurrent gastric cancer, he complained of colic pain. CT examination revealed a marked dilation of the duodenum suggesting the presence of a distal duodenal stricture resulting from the known recurrent tumor. To palliate this intestinal obstruction, we successfully placed an expandable metal stent(EMS) using a double-balloon enteroscope(DBE), which achieved immediate relief of the obstruction and enabled the resumption of oral intake and chemotherapy. While the endoscopic placement of an EMS is available for malignant gastro-intestinal obstruction, it is considerably more difficult to approach the duodenum with Roux-en-Y anastomosis. A DBE has made it possible to place an EMS deep in the small intestine. In the present case, this minimally invasive procedure avoided the need for surgery and greatly contributed to palliation. Thus, EMS placement using a DBE is a possible palliative treatment for malignant small bowel obstruction.
authors.affiliation: Dept. of Gastrointestinal Surgery, Okayama University Hospital, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Oiwa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kishimoto
authors.forename: Futoshi
authors.initials: F
authors.lastname: Uno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nishizaki
authors.forename: Aiko
authors.initials: A
authors.lastname: Kono
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D003131:Combined Modality Therapy; D058582:Double-Balloon Enteroscopy; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy*; D017809:Fatal Outcome; D005743:Gastrectomy; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000188:drug therapy; D015607:Stents; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D017239:Paclitaxel