Clin Endosc.  2014 Jan;47(1):108-111.

Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique

• Popa D
• Ramesh J
• Peter S
• Wilcox CM
• Monkemuller K

Abstract

Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

Keyword

Balloon-assisted enteroscopy; Overtube; Metal stent; Small bowel obstruction; Double-balloon enteroscopy

MeSH Terms

Colon
Constriction, Pathologic
Double-Balloon Enteroscopy
Intestine, Small
Palliative Care
Phenobarbital
Stents
Phenobarbital

Figure

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  Fig. 1 The previously placed self-expanding metal stent was obstructed owing to tissue ingrowth and the small bowel kinking distally to the stent.

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  Fig. 2 The enteroscope was introduced into the overtube, across the stenosis, and into the jejunum.

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  Fig. 3 The scope was removed under fluoroscopic guidance, leaving the wire in place inside the overtube across the small bowel stricture.

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  Fig. 4 The overtube now lies along the lesser curvature of the stomach. On previous attempts without an overtube in place, the stent followed the wire along the greater curvature, making it practically impossible to place the stent across the previous stents.

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  Fig. 5 Overtube straightening was essential to advance the stent over the wire through the tube and then across the previous stents.

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  Fig. 6 The distal part of the stent was deployed under fluoroscopic guidance while the now deflated overtube was carefully brought back into the stomach through the old stent, thus permitting deployment of the new stent distal to the old stent and the overtube tip across the obstruction.

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  Fig. 7 Full deployment of stent-in-stent with perfect distal positioning is confirmed.

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