Óscar Álvarez

Initial Experience with Song's Covered Duodenal Stent in the Treatment of Malignant Gastroduodenal Obstruction

PURPOSE Initial experience with use of Songs covered duodenal stent in the treatment of malignant gastroduodenal obstruction is reported. MATERIALS AND METHODS Sixteen consecutive patients with malignant gastroduodenal obstruction were treated with peroral placement of Songs covered duodenal stent. The mean age was 58 years (range, 28-90 y). Gastroduodenal obstruction was caused by gastric (n = 8), metastatic (n = 2), gallbladder (n = 3), pancreatic (n = 2), or ampullary (n = 1) cancer. The disease was considered inoperable in all patients. With use of a flexible 20-F introducing system, seven fully covered, three uncovered, and 10 partially covered duodenal stents were placed under fluoroscopic guidance. RESULTS The technical success rate was 94% (15 of 16) with no major complications. Symptoms of gastroduodenal obstruction improved in 14 patients. Stent migration was observed in three of seven fully covered stents. Patients with migrated stents required endoscopic stent removal and placement of uncovered duodenal stents. Tumor ingrowth was observed in two thirds of uncovered stents. In the 10 procedures with partially covered duodenal stents, no migration or tumor ingrowth was observed. All patients died 1-48 weeks (mean, 12 weeks) after stent placement. CONCLUSION Peroral placement of Songs covered duodenal stent is a feasible and effective method of palliation in the majority of patients with malignant gastroduodenal obstruction. Migration of fully covered stents and tumor ingrowth of uncovered stents are important limitations that can be overcome with the use of a partially covered duodenal stent.

Jejunal phlebectasia presenting with massive gastrointestinal hemorrhage.

Our case report illustrates the clinicopathologic features of this rare vascular lesion and highlights that phlebectasia should be considered as a cause of gastrointestinal bleeding of undetermined etiology in adult patients.

Endometriosis with massive bloody ascites.

Endometriosis is commonly found in 10 to 15 percent of women aged between 25 and 44 years,! and it has been estimated that 25 to 40 percent of infertile women have endometriosis.! In this report, we describe a patient with endometriosis whose signs were massive bloody ascites. The purpose of this report is to increase awareness among physicians of the varied clinical manifestations of intestinal endometriosis.

Acute duodenal obstruction after percutaneous placement of metallic biliary stents: peroral treatment with enteral stents.

Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention.

Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo

Antecedentes: las estenosis benignas, la ruptura del tracto digestivo y las fistulas digestivas son condiciones que ponen en riesgo la vida y que por lo general son tratadas quirurgicamente. Ahora, ha surgido la coloca- cion de stents metalicos parcial o totalmente cubiertos como una opcion de manejo con minima invasion. Se pretende determinar la efectividad clinica de un nuevo diseno de stent de nitinol totalmente cubierto para el tratamiento de las perforaciones digestivas y las fistulas anastomoticas, con especial enfasis en la evaluacion de la hiperplasia reactiva. Metodos: en el periodo 2012-2013 se coloco un stent de nitinol autoexpandible totalmente cubierto en 15 pacientes con perforaciones benignas de esofago, fistulas anastomoticas, estenosis despues de cirugia gastrointestinal alta o baja. Se utilizo un stent de mayor diametro en su centro (20 mm) y en su porcion proximal (28 mm). Se recolectaron datos demograficos, tipo de lesion, ubicacion del stent y remocion, exito clinico y complicaciones. Resultados: a un total de 15 pacientes se les puso 15 nuevos stents por fistulas anastomoticas (n = 8), estenosis esofagica (n = 2), estenosis en anastomosis colorrectal (n = 2), estenosis de anastomosis gastro- yeyunal (n = 1), ruptura iatrogenica de esofago (n = 1), y estenosis pilorica (n = 1). La remocion endoscopica del stent fue exitosa en todos los pacientes, y una fue particularmente dificil por hiperplasia reactiva. El exito clinico se logro en 9 pacientes (73%), con una media de permanencia del stent de 10 semanas (rango 7 a 12 semanas). En total, ocurrieron 7 complicaciones en 15 pacientes (47%): hiperplasia reactiva (n = 1), migracion (n = 3), dolor severo (n = 2), ulceracion esofagica (n = 1), y solo 1 paciente requirio cirugia despues del fallo del stent. Ningun paciente fallecio como consecuencia de la colocacion del mismo. Conclusiones: un stent totalmente cubierto, con nuevo diseno, dejado por 10 semanas, puede ser una alternativa a la cirugia en el tratamiento de perforaciones digestivas, estenosis o fistulas anastomoticas. La eficacia entre el nuevo stent y el convencional es diferente, su eleccion depende de los riesgos esperados de migracion y de hiperplasia reactiva.

Inflammatory bowel disease in the critically ill

Ulcerative colitis and Crohns disease are characterized by a chronic relapsing course, often requiring multiple medical and surgical interventions. Despite their chronicity, these conditions can present as true and potentially life-threatening gastrointestinal emergencies as well as extraintestinal emergencies. The successful management of such complications depends on early diagnosis and the judicious and timely use of both medical and surgical therapies.