title: Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction.
abstract: BACKGROUND
  Self-expandable metallic stent placement is widely used to manage malignant gastroduodenal obstructions. However, there are difficulties in negotiating a guidewire (GW) and a stent delivery system (SDS).
  
  
  OBJECTIVE
  To investigate feasibility, usefulness, and safety of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstructions.
  
  
  METHODS
  In July 2001 to August 2011, 726 patients with malignant gastroduodenal obstructions underwent stent placement. Guiding sheath was used in patients in whom a GW could not be passed through the obstruction and a SDS failed to reach the obstruction. Sheath usefulness was evaluated based on the ability of the sheath to successfully assist. The technical success rate and the most frequent reasons for the use of a sheath were evaluated.
  
  
  RESULTS
  The guiding sheath was needed in 148 of 726 patients (20%). The overall technical success rate was 98% with the guiding sheath. In two of 148 patients, stent placement failed because, the GW could not be passed through the obstruction, in the other, the SDS could not be passed. A minority of patients reported mild discomfort. Patients with pancreatic cancer and duodenal obstruction were significantly more likely to require the use of guiding sheaths (P = 0.002, P < 0.001, respectively).
  
  
  CONCLUSIONS
  Using a guiding sheath for fluoroscopic stent placement appears to be feasible, useful and safe in patients with malignant gastroduodenal obstructions.
authors.affiliation: Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Myoung Sun
authors.initials: MS
authors.lastname: Kim
authors.forename: Rosa
authors.initials: R
authors.lastname: Chung
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Han Kyu
authors.initials: HK
authors.lastname: Na
authors.forename: Deok Ho
authors.initials: DH
authors.lastname: Nam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004380:Duodenal Obstruction / Q000473:pathology* / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D017219:Gastric Outlet Obstruction / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome