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Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture

World Journal of Gastrointestinal Endoscopy 2018年第6期10卷 117-120页

作者： Muhammad Sohail Mansoor Juan Tejada Nour A Parsa Eric Yoon sven hida Department of Gastroenterology Albany Medical Center

We are reporting a novel "off-label" use of lumen apposing metal stent(LAMS) for management of refractory gastro-jejunal(GJ) anastomotic stricture after Roux-en-y gastric bypass(RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent(fc SEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient's symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.

关键词： Gastro-jejunal anastomotic stricture Lumen apposing metal stent Dysphagia Roux-en-Y gastric bypass

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Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis,a novel technique for malignant obstruction:A case report and review of literature

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World Journal of Gastrointestinal Endoscopy 2018年第9期10卷 219-224页

作者： Gurjiwan Singh Virk Nour A Parsa Juan Tejada Muhammad Sohail Mansoor sven hida Department of Medicine Albany Medical Center Department of Gastroenterology Albany Medical Center

For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of *** through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct(CBD).We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic *** biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

关键词： Bare metal stent Endoscopic retrograde cholangiopancreatography Common bile duct Selfexpanding metal stent Jaundice Biliary obstruction Gastric outlet obstruction

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