A small bowel obstruction due to peritoneal carcinomatosis that was successfully palliated with endoscopic SEMS

Yıl 2012, Cilt: 11 Sayı: 2, 81 - 93, 01.08.2012

Serkan Torun Erkan Parlak Selçuk Dişibeyaz Yavuz Beyazıt Nurgül Şaşmaz

Öz

The routine use of self-expandable metallic stents in the palliation of esophageal, biliary system and left-sided colonic neoplasms is well known, but there is only limited evidence that related to the use of self-expandable metallic stents in obstructions due to small bowel neoplasms. Therefore, it is crucial for centers to report their experiences in small bowel obstructions that was treated successfully with endoscopic drainage procedures. We herein would like to share our previous experience in a patient with small bowel obstruction due to peritoneal carcinomatosis that was successfully palliated with endoscopic self-expandable metallic stents replacement, despite its technical difficulties and common failure rates. Although the patients with peritoneal carcinomatosis present with accompanying lesions, external impression and long segment obstruction that leads to difficulties while stent replacement, it can be an acceptable alternative to surgical routes in selected cases.

Anahtar Kelimeler

Key words: Metallic stent, small bowel obstruction, endoscopic treatment

Metal stent (SEMS) ile palyasyonu sağlanan peritoneal karsinomatozis'e bağlı malign ince barsak tıkanıklığı olgusu

Öz

Kendiliğinden açılabilir metal stentler özellikle özofagus, biliyer sistem ve sol kolon tümörlerinin palyatif tedavisinde rutin olarak kullanılmakla birlikte, benign yada malign sebeplere bağlı ince barsak darlıklarında kullanımı ile ilgili bilgiler kısıtlıdır. Bu nedenle özellikle ince barsak kaynaklı darlıklarda başarılı bir şekilde uygulanan endoskopik drenaj işlemlerinin merkezler tarafından rapor edilmesi büyük önem arz etmektedir. Bu nedenle biz burada endoskopik stentlemenin hem teknik olarak zor hemde sonuçlarının sıklıkla başarısız olduğu peritoneal karsinomatozis'e bağlı ince barsak tıkanıklığı olan ve endoskopik olarak konulan kendiliğinden açılabilir metalik stent ile palyasyonu sağlanan bir olguyu paylaşmak istiyoruz. Her ne kadar peritoneal karsinomatozis hastalarında, eş zamanlı lezyonların varlığı, eksternal bası ve uzun segment tıkanıklık nedeniyle stentleme bazı zorluklar gösterse de sınırlı lokalizasyonu olan seçilmiş vakalarda cerrahi tedavinin makul bir alternatifi olabilir.

Anahtar Kelimeler

Metalik stent, ince barsak obstrüksiyonu, endoskopik tedavi

Kaynakça

• Moss AC, Morris E, Leyden J, MacMathuna P. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev 2007;33:213-21.
• Patton JT, Carter R. Endoscopic stenting for recurrent malignant gastric outlet obstruction. Br J Surg 1997; 84:865-6.
• Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 2002;97:72-8.
• Baron TH. Optimizing endoscopic placement of expandable stents throughout the GI tract. Expert Rev Gastroenterol Hepatol 2008;2:399-409.
• Baron TH, Dean PA, Yates MR 3rd, et al. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc 1998; 47:277-86.
• Repici A, Adler DG, Gibbs CM, et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc 2007;66:940-4.
• Paul L, Pinto I, Gomez H, et al. Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 2002;223:715-22.
• Dormann AJ, Deppe H, Wigginghaus B. Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract-first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Z Gastroenterol 2001;39:957-60.
• Guan YS, Sun L, Li X, Zheng XH. Successful management of a benign anastomotic colonic stricture with self-expanding metallic stents: a case report. World J Gastroenterol 2004;10:3534-6.
• Saida Y, Sumiyama Y, Nagao J. Self-expandable metallic stent in the treatment of colorectal obstruction. Nippon Geka Gakkai Zasshi 2003;104:554-7.
• Mainar A, De Gregorio Ariza MA, Tejero E, et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery-results of a multicenter study. Radiology 1999; 210:65-9.
• Jeurnink SM, Steyerberg EW, van Hooft JE, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010;71:490-9.
• Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004; 36:543-50.
• Miyayama S, Matsui O, Kifune K, et al. Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent. Am J Roentgenol 2000;175:1631-7.
• Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007;246:24-30.
• Lo SK. Metallic stenting for colorectal obstruction. Gastrointest Endosc Clin N Am 1999;9:459-77.
• Manes G, de Bellis M, Fuccio L, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg 2011;146:1157-62.
• Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096-