title: Feasibility of self-expandable metal stent placement with side-viewing endoscope for malignant distal duodenal obstruction.
abstract: OBJECTIVE
  Self-expandable metal stents (SEMSs) have been a good treatment option for malignant intestinal obstruction. However, stent placement with a gastroscope can be technically difficult for the distal duodenum obstruction. A side-viewing duodenoscope may be helpful for these patients. We report our experiences in the insertion of SEMSs to distal duodenum with a side-viewing endoscope.
  
  
  METHODS
  We retrospectively analyzed our database of SEMS placement for malignant distal duodenum obstruction between April 2006 and April 2013. All patients underwent SEMS placement using the side-viewing endoscope (duodenoscope). Main outcomes are technical success, clinical success, complication rates, stent patency, and overall survival. In addition, database from other tertiary center was analyzed, where SEMS insertion was performed with forward-viewing endoscopes (gastroscope or colonoscope). Success and complication rates were compared with ours.
  
  
  RESULTS
  A total of 31 patients were reviewed. Pancreatic cancer was the most common cause (87.1 %). Technical and clinical success was achieved in all cases. Procedure-related complication occurred in one patient, who experienced micro-perforation of the duodenum. The patient improved with conservative treatment. Median duration of stent patency was 125 days (95 % CI 75-175), and median overall survival was 134 days (95 % CI 77-191). Biliary obstruction was present in 12.9 % of patients, who underwent biliary stent placement at the same time without changing endoscopes. In forward-viewing endoscopes group, 15 cases were included. Technical and clinical success was achieved in all cases, and no procedure-related complication occurred.
  
  
  CONCLUSIONS
  The insertion of SEMSs to distal duodenum with a duodenoscope could be performed effectively and safely in patients with malignant obstruction.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea, youreon.park@gmail.com.
authors.forename: Jin Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Byung-Hoon
authors.initials: BH
authors.lastname: Min
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Chung
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Byeong Jun
authors.initials: BJ
authors.lastname: Song
authors.forename: Jun Kyu
authors.initials: JK
authors.lastname: Lee
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
mesh_terms: D000368:Aged; D016208:Databases, Factual; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals