Loading...
Please wait, while we are loading the content...
Similar Documents
Placement of a lumen-apposing metal stent for palliation of malignant pyloric stenosis
| Content Provider | Scilit |
|---|---|
| Author | Trindade, Arvind J. Hung, Chun Kit Zimmerman, Howard M. Benias, Petros C. |
| Copyright Year | 2018 |
| Description | A 66-year-old woman with metastatic breast cancer and diffuse osseous disease presented with a history of vomiting after meals for 3 weeks. A computed tomography (CT) scan showed nodular wall thickening of the gastric antrum/first part of the duodenum, which was suspicious for serosal metastatic disease causing gastric outlet obstruction ([Fig. 1]). An upper gastrointestinal endoscopy was performed for evaluation. A pyloric stricture was visualized ([Fig. 2]). The standard adult gastroscope could not traverse the lesion; however, a pediatric gastroscope was able to traverse the lesion and showed a short (< 1 cm) pyloric stricture. The mucosa appeared normal, consistent with the CT findings of serosal disease causing the stricture through extrinsic compression. The stricture was also defined under fluoroscopy, which confirmed the endoscopic findings ([Fig. 3]). Given the short stricture and possible concerns about migration of a traditional duodenal stent, the decision was made to place a 15 × 10-mm fully covered lumen-apposing metal stent (LAMS; Axios; Boston Scientific, Natick, Massachusetts. USA). The stent was placed under endoscopic and fluoroscopic guidance ([Fig. 4]; [Video 1]) using a single-channel therapeutic gastroscope and was successfully deployed. The barbell-shaped LAMS was shown to be straddling the stricture well on endoscopic and fluoroscopic views, which will help prevent migration. After placement of the stent, the patient has had no further symptoms of gastric outlet obstruction and was still tolerating a pureed/soft diet at 4-week follow-up. Video 1 Placement of a lumen-apposing metal stent for a malignant pyloric stenosis. To our knowledge, this is the first report of the placement of a LAMS for malignant pyloric stenosis. There are 10 cases in the literature reporting the use of LAMS for benign pyloric stenosis caused by ulcer disease, with variable long-term success [1] [2] [3]. We have shown in this case that placement of a LAMS is also a therapeutic option for malignant pyloric stenoses in which the stricture is less than 1 cm. Endoscopy_UCTN_Code_TTT_1AS_2AG |
| Related Links | http://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-0624-1140.pdf |
| Ending Page | E211 |
| Page Count | 2 |
| Starting Page | E210 |
| e-ISSN | 14388812 |
| DOI | 10.1055/a-0624-1140 |
| Journal | Endoscopy |
| Issue Number | 08 |
| Volume Number | 50 |
| Language | English |
| Publisher | Georg Thieme Verlag KG |
| Publisher Date | 2018-06-12 |
| Access Restriction | Open |
| Subject Keyword | Journal: Endoscopy Gastroenterology and Hepatology Apposing Metal Stent Lumen Apposing Metal |
| Content Type | Text |
| Resource Type | Article |
