RESUMO
The use of self-expandable enteral stents for palliation of malignant stenosis may present the complication of concealing the ampulla of Vater behind the metallic mesh. Anchoring in the duodenal wall (distal or partial migration) may also be a complication of biliary metallic stents and therefore may cause difficulty in gaining access to the biliary tract. In these cases of difficult access, a fenestration on the prosthesis ( biliary or enteral) can be created to allow reaching the obstructed biliary tract by means of argon plasma (AP). Were retrospectively analysed 7 cases. Under endoscopic vision, AP was directed to filgurate and cut 6 biliary prosthesis and a duodenal stent. Fulguration and cut of biliary stent was performed in 5 cases of distal partial migration and cholangitis. In one case of obstruction caused by distal migration inside the duodenal stent light, cutting of the biliary stent was performed. A window was created in the enteral prosthesis in order to access the ampulla of Vater and place a biliary tract prosthesis. All cases were resolved successfully and without complications. We conclude that the use of AP to fulgurate and cut nitinol prosthesis was effective and presented no complications in this series.
Assuntos
Coagulação com Plasma de Argônio , Obstrução Duodenal/terapia , Neoplasias Pancreáticas/complicações , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo , Obstrução Duodenal/etiologia , Humanos , Pessoa de Meia-Idade , Cuidados Paliativos , Neoplasias Pancreáticas/terapia , Estudos RetrospectivosRESUMO
INTRODUCTION: The endoscopic placement of self-expanding metallic stents (SEMS) emerges as a therapeutic option for neoplastic colonic obstruction in two situations: as palliative treatment and as a bridge to surgery. The latter can avoid emergency surgery, thus decreasing the rate of ostomies and the mortality and morbidity associated with them. OBJECTIVES: To evaluate the feasibility, safety and benefits of SEMS placement for the treatment of neoplastic colorectal obstruction. MATERIALS AND METHODS: Between August 2008 and June 2012, we included in this prospective, longitudinal, descriptive and observational study all the patients suffering from colorectal neoplasia who were subjected to SEMS placement by the same group ofendoscopists. Nitinol SEMS were inserted under endoscopic vision and radioscopic control. RESULTS: Twenty seven SEMS were inserted in 27 patients, 61% of them were male and the average age was 70 years old. Symptoms of colonic suboclussion or obstruction were found in 92% of patients, 88% of the lesions were located in the left-side colon, 41% of cases were performed on an ambulatory basis and 65% of stenting was carried out for palliative purposes. The average time of hospitalization was 6,46 days. Technical and clinical success were 93% and 100%, respectively. Minor complications were observed in 11% of patients. Colonic stenting was followed by elective surgery within one month, by a laparoscopic technique in most cases. CONCLUSION: The placement of SEMS arises as a safe and effective alternative to palliative surgery or as a bridge to elective surgery.
Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The endoscopic placement of self-expanding metallic stents (SEMS) emerges as a therapeutic option for neoplastic colonic obstruction in two situations: as palliative treatment and as a bridge to surgery. The latter can avoid emergency surgery, thus decreasing the rate of ostomies and the mortality and morbidity associated with them. OBJECTIVES: To evaluate the feasibility, safety and benefits of SEMS placement for the treatment of neoplastic colorectal obstruction. MATERIALS AND METHODS: Between August 2008 and June 2012, we included in this prospective, longitudinal, descriptive and observational study all the patients suffering from colorectal neoplasia who were subjected to SEMS placement by the same group ofendoscopists. Nitinol SEMS were inserted under endoscopic vision and radioscopic control. RESULTS: Twenty seven SEMS were inserted in 27 patients, 61
of them were male and the average age was 70 years old. Symptoms of colonic suboclussion or obstruction were found in 92
of patients, 88
of the lesions were located in the left-side colon, 41
of cases were performed on an ambulatory basis and 65
of stenting was carried out for palliative purposes. The average time of hospitalization was 6,46 days. Technical and clinical success were 93
and 100
, respectively. Minor complications were observed in 11
of patients. Colonic stenting was followed by elective surgery within one month, by a laparoscopic technique in most cases. CONCLUSION: The placement of SEMS arises as a safe and effective alternative to palliative surgery or as a bridge to elective surgery.
Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Prospectivos , Resultado do TratamentoRESUMO
The use of self-expandable enteral stents for palliation of malignant stenosis may present the complication of concealing the ampulla of Vater behind the metallic mesh. Anchoring in the duodenal wall (distal or partial migration) may also be a complication of biliary metallic stents and therefore may cause difficulty in gaining access to the biliary tract. In these cases of difficult access, a fenestration on the prosthesis ( biliary or enteral) can be created to allow reaching the obstructed biliary tract by means of argon plasma (AP). Were retrospectively analysed 7 cases. Under endoscopic vision, AP was directed to filgurate and cut 6 biliary prosthesis and a duodenal stent. Fulguration and cut of biliary stent was performed in 5 cases of distal partial migration and cholangitis. In one case of obstruction caused by distal migration inside the duodenal stent light, cutting of the biliary stent was performed. A window was created in the enteral prosthesis in order to access the ampulla of Vater and place a biliary tract prosthesis. All cases were resolved successfully and without complications. We conclude that the use of AP to fulgurate and cut nitinol prosthesis was effective and presented no complications in this series.
RESUMO
INTRODUCTION: The endoscopic placement of self-expanding metallic stents (SEMS) emerges as a therapeutic option for neoplastic colonic obstruction in two situations: as palliative treatment and as a bridge to surgery. The latter can avoid emergency surgery, thus decreasing the rate of ostomies and the mortality and morbidity associated with them. OBJECTIVES: To evaluate the feasibility, safety and benefits of SEMS placement for the treatment of neoplastic colorectal obstruction. MATERIALS AND METHODS: Between August 2008 and June 2012, we included in this prospective, longitudinal, descriptive and observational study all the patients suffering from colorectal neoplasia who were subjected to SEMS placement by the same group ofendoscopists. Nitinol SEMS were inserted under endoscopic vision and radioscopic control. RESULTS: Twenty seven SEMS were inserted in 27 patients, 61
of them were male and the average age was 70 years old. Symptoms of colonic suboclussion or obstruction were found in 92
of the lesions were located in the left-side colon, 41
of cases were performed on an ambulatory basis and 65
of stenting was carried out for palliative purposes. The average time of hospitalization was 6,46 days. Technical and clinical success were 93
, respectively. Minor complications were observed in 11
of patients. Colonic stenting was followed by elective surgery within one month, by a laparoscopic technique in most cases. CONCLUSION: The placement of SEMS arises as a safe and effective alternative to palliative surgery or as a bridge to elective surgery.
Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Obstrução Intestinal/etiologia , Stents , Adulto , Colonoscopia/métodos , Cuidados Paliativos , Estudos Longitudinais , Estudos Prospectivos , Feminino , Humanos , Idoso , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
The use of self-expandable enteral stents for palliation of malignant stenosis may present the complication of concealing the ampulla of Vater behind the metallic mesh. Anchoring in the duodenal wall (distal or partial migration) may also be a complication of biliary metallic stents and therefore may cause difficulty in gaining access to the biliary tract. In these cases of difficult access, a fenestration on the prosthesis ( biliary or enteral) can be created to allow reaching the obstructed biliary tract by means of argon plasma (AP). Were retrospectively analysed 7 cases. Under endoscopic vision, AP was directed to filgurate and cut 6 biliary prosthesis and a duodenal stent. Fulguration and cut of biliary stent was performed in 5 cases of distal partial migration and cholangitis. In one case of obstruction caused by distal migration inside the duodenal stent light, cutting of the biliary stent was performed. A window was created in the enteral prosthesis in order to access the ampulla of Vater and place a biliary tract prosthesis. All cases were resolved successfully and without complications. We conclude that the use of AP to fulgurate and cut nitinol prosthesis was effective and presented no complications in this series.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Stents , Obstrução Duodenal/terapia , Coagulação com Plasma de Argônio , Cuidados Paliativos , Neoplasias Pancreáticas/terapia , Estudos Retrospectivos , Remoção de Dispositivo , Obstrução Duodenal/etiologiaRESUMO
INTRODUCTION: Gastric outlet obstruction is a complication that can occur in the evolution of patients with pancreatic adenocarcinoma. Self-expanding metal stents (SEMS) resolve this situation by endoscopy, thus avoiding a laparoscopic gastroenterotomy. The aim of our study is to report our experience in the palliative treatment with SEMS of gastroduodenal neoplasic obstruction at a monovalent gastroenterology institute in Mar del Plata. PATIENTS AND METHODS: All patients with symptoms of gastric outlet obstruction of neoplasic origin who fit for SEMS between January 2006 and February 2011 were included. Data were collected regarding the patients' clinical characteristics as well as the type of tumor and the efficacy of the procedure measured according to success and complication rates, length of hospital stay and evaluation of clinical benefit, according to performance status scales and gastric outlet obstruction score (GOOS). RESULTS: A total of 17 prosthesis placed in 16 patients were analyzed. In all cases the procedure was completed successfully. The intervention was performed on an outpatient basis in 12 patients (75%). One patient presented within 7 days gastric haemorrhage related with the stent, who was early treated with argon plasma. Late expected com- plications due to prolonged survival were observed in 60% of patients. None of them was serious and resolved spontaneously or by endoscopic treatment. Average survival was 117 days (range 3 to 300 days) and most patients showed subjective improvement in GOOS scale. CONCLUSIONS: SEMS have a high rate of technical and clinical success. However, they are scarcely known in our field. They present an insignificant number of early complications and the resolution of later ones is quite easy. An improvement in GOOS scale and quality of life is achieved.
Assuntos
Neoplasias Duodenais/complicações , Obstrução da Saída Gástrica/cirurgia , Neoplasias Pancreáticas/complicações , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Obstrução da Saída Gástrica/etiologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Adenoma Viloso/complicações , Ampola Hepatopancreática , Colestase/diagnóstico , Colestase/etiologia , Doenças do Ducto Colédoco/etiologia , Neoplasias Duodenais/complicações , Adenoma Viloso/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças do Ducto Colédoco/diagnóstico , Dilatação Patológica/diagnóstico , Neoplasias Duodenais/diagnóstico , Humanos , Masculino , SíndromeAssuntos
Humanos , Masculino , Idoso , Adenoma Viloso/complicações , Doenças do Ducto Colédoco/etiologia , Neoplasias Duodenais/complicações , Ampola Hepatopancreática , Adenoma Viloso/diagnóstico , Colestase/diagnóstico , Colestase/etiologia , Doenças do Ducto Colédoco/diagnóstico , Dilatação Patológica/diagnóstico , Neoplasias Duodenais/diagnóstico , SíndromeAssuntos
Humanos , Masculino , Idoso , Doenças do Ducto Colédoco/etiologia , Adenoma Viloso/complicações , Neoplasias Duodenais/complicações , Doenças do Ducto Colédoco/diagnóstico , Adenoma Viloso/diagnóstico , Neoplasias Duodenais/diagnóstico , Colestase/diagnóstico , Colestase/etiologia , Dilatação Patológica/diagnóstico , Ampola Hepatopancreática , Síndrome , Idoso de 80 Anos ou maisRESUMO
El objetivo de este trabajo fue evaluar la sensibilidad, especificidad y valor predictivo positivo y negativo de la colangiografía por Resonancia Magnética (MRCP) en pacientes con patología biliar obstructiva benigna y maligna. Se estudiaron por MRCP 106 pacientes con sospecha de patología biliar en secuencias 3D turbo SPIN-ECO T2 con técnica de supresión grasa: 49 presentaron obstrucción biliar, de los cuales 48 fueron correctamente diagnosticados, con una sensibilidad del 92 por ciento, especificidad del 90 por ciento, VPP del 94 por ciento y VPN del 88 por ciento. Concluimos que la MRCP es un nuevo procedimiento diagnóstico no invasivo que muestra alta sensibilidad y especificidad en el diagnóstico de lesiones benignas y malignas del árbol biliopancreático (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Colestase/diagnóstico , Colestase Extra-Hepática/diagnóstico , Espectroscopia de Ressonância Magnética/diagnóstico , Colangiografia/métodos , Colestase/etiologia , Colestase Extra-Hepática/etiologia , Colelitíase/diagnóstico , Cálculos Biliares/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/diagnóstico , Imageamento por Ressonância Magnética/normas , Sensibilidade e EspecificidadeRESUMO
El objetivo de este trabajo fue evaluar la sensibilidad, especificidad y valor predictivo positivo y negativo de la colangiografía por Resonancia Magnética (MRCP) en pacientes con patología biliar obstructiva benigna y maligna. Se estudiaron por MRCP 106 pacientes con sospecha de patología biliar en secuencias 3D turbo SPIN-ECO T2 con técnica de supresión grasa: 49 presentaron obstrucción biliar, de los cuales 48 fueron correctamente diagnosticados, con una sensibilidad del 92 por ciento, especificidad del 90 por ciento, VPP del 94 por ciento y VPN del 88 por ciento. Concluimos que la MRCP es un nuevo procedimiento diagnóstico no invasivo que muestra alta sensibilidad y especificidad en el diagnóstico de lesiones benignas y malignas del árbol biliopancreático