How to treat intestinal obstruction due to malignant recurrence after Whipple's resection for pancreatic head cancer: description of 2 new endoscopic techniques

作     者：Christina Mouradides Alaa Taha Ivan Borbath Pierre H Deprez Tom G Moreels 

作者机构：Cliniques universitaires Saint-Luc 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第33期

页      面：6181-6186页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Intestinal obstruction Self-expandable metal stent Whipple’s pancreatico-duodenectomy 

摘      要：The prognosis of pancreatic cancer remains poor,even after initial surgical therapy. Local recurrence after Whipple s pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a selfexpandable metal stent(SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple s resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing Hot Axios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple s resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.