Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

  • Won Seok Choi (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Chang Jin Yoon (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Jae Hwan Lee (Department of Radiology, Seoul National University Bundang Hospital)
  • Received : 2020.05.30
  • Accepted : 2020.11.03
  • Published : 2021.05.01
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Abstract

Objective: To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy. Materials and Methods: Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated. Results: The stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively. Conclusion: Percutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.

Keywords

Acknowledgement

This research was supported by grant no 14-2019-026 from the Seoul National University Bundang Hospital Research Fund.

References

  1. Morikawa S, Suzuki A, Nakase K, Yasuda K. Palliation of malignant upper gastrointestinal obstruction with self-expandable metal stent. Korean J Radiol 2012;13 Suppl 1:S98-S103
  2. Pais-Cunha I, Castro R, Libanio D, Pita I, Bastos RP, Silva R, et al. Endoscopic stenting for palliation of intra-abdominal gastrointestinal malignant obstruction: predictive factors for clinical success. Eur J Gastroenterol Hepatol 2018;30:1033-1040
  3. Kim J, Choi IJ, Kim CG, Lee JY, Cho SJ, Park SR, et al. Self-expandable metallic stent placement for malignant obstruction in patients with locally recurrent gastric cancer. Surg Endosc 2011;25:1505-1513
  4. Bekheet N, Kim MT, Park JH, Kim KY, Tsauo J, Zhe W, et al. Fluoroscopic gastroduodenal stent placement in 55 patients with endoscopic stent placement failure. Cardiovasc Intervent Radiol 2018;41:1233-1240
  5. Bakheet N, Tsauo J, Song HY, Kim KY, Park JH, Wang Z, et al. Fluoroscopic self-expandable metallic stent placement for treating post-operative nonanastomotic strictures in the proximal small bowel: a 15-year single institution experience. Br J Radiol 2019;92:20180957
  6. Jinno N, Naitoh I, Nagura Y, Fujioka K, Mizuno Y, Momose J, et al. Percutaneous transhepatic self-expanding metallic stent placement for the treatment of malignant afferent loop obstruction. Intern Med 2018;57:333-337
  7. Gwon DI. Percutaneous transhepatic placement of covered, self-expandable nitinol stent for the relief of afferent loop syndrome: report of two cases. J Vasc Interv Radiol 2007;18:157-163
  8. Han K, Song HY, Kim JH, Park JH, Nam DH, Ryu MH, et al. Afferent loop syndrome: treatment by means of the placement of dual stents. AJR Am J Roentgenol 2012;199:W761-W766
  9. Park JH, Song HY, Kim MS, Chung R, Kim JH, Na HK, et al. Usefulness of a guiding sheath for fluoroscopic stent placement in patients with malignant gastroduodenal obstruction. Acta Radiol 2013;54:267-271
  10. Holt AP, Patel M, Ahmed MM. Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc 2004;60:1010-1017
  11. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14:S199-S202
  12. Song HY, Kim TH, Choi EK, Kim JH, Kim KR, Shin JH, et al. Metallic stent placement in patients with recurrent cancer after gastrojejunostomy. J Vasc Interv Radiol 2007;18:1538-1546
  13. Park JH, Song HY, Kim SH, Shin JH, Kim JH, Kim BS, et al. Metallic stent placement in patients with recurrent malignant obstruction in the surgically altered stomach. Ann Surg Oncol 2014;21:2036-2043
  14. Shiau EL, Liang HL, Lin YH, Li MF, Chiang CL, Chen MC, et al. The complication of hepatic artery injuries of 1,304 percutaneous transhepatic biliary drainage in a single institute. J Vasc Interv Radiol 2017;28:1025-1032
  15. Choi SH, Gwon DI, Ko GY, Sung KB, Yoon HK, Shin JH, et al. Hepatic arterial injuries in 3110 patients following percutaneous transhepatic biliary drainage. Radiology 2011;261:969-975
  16. Chen H, Wu S, Kundra A, Aja Onu I, Gotlieb V, Wang JC. Gastric perforation in a patient receiving neoadjuvant chemoradiotherapy. World J Oncol 2015;6:383-386
  17. Ye BW, Chou CK, Hsieh YC, Li CP, Chao Y, Hou MC, et al. Metallic stent expansion rate at day one predicts stent patency in patients with gastric outlet obstruction. Dig Dis Sci 2017;62:1286-1294
  18. Sasaki R, Sakai Y, Tsuyuguchi T, Nishikawa T, Fujimoto T, Mikami S, et al. Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: a prospective Japanese multicenter study. World J Gastroenterol 2016;22:3837-3844
  19. Yamao K, Kitano M, Kayahara T, Ishida E, Yamamoto H, Minaga K, et al. Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan. Gastrointest Endosc 2016;84:757-763.e6