Case Report
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 28, 2010; 16(24): 3087-3090
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3087
Stone extraction balloon-guided repeat self-expanding metal stent placement
Hyung Hun Kim, Jeong Seop Moon, Soo Hyung Ryu, Jung Hwan Lee, You Sun Kim
Hyung Hun Kim, Jeong Seop Moon, Soo Hyung Ryu, Jung Hwan Lee, You Sun Kim, Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 100-032, South Korea
Author contributions: Kim HH took care of the patient and wrote this paper; Moon JS guided writing of this paper and made the decision to treat the patient; Kim YS, Lee JH and Ryu SH discussed this case and gave advice about the technique.
Correspondence to: Jeong Seop Moon, MD, Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 2-Ga, Jeo-Dong, Jung-Gu, Seoul 100-032, South Korea. moonjs2@unitel.co.kr
Telephone: +82-2-22700012 Fax: +82-2-22794021
Received: March 12, 2010
Revised: April 11, 2010
Accepted: April 18, 2010
Published online: June 28, 2010
Abstract

Self-expanding metal stent (SEMS) placement offers safe and effective palliation in patients with upper gastrointestinal obstruction due to a malignancy. Well described complications of SEMS placement include tumor growth, obstruction, and stent migration. SEMS occlusions are treated by SEMS redeployment, argon plasma coagulation application, balloon dilation, and surgical bypass. At our center, we usually place the second SEMS into the first SEMS if there is complete occlusion by the tumor. We discovered an unusual complication during SEMS redeployment. The guidewire passed through the mesh of the first SEMS and caused the second SEMS to become entangled with the first SEMS. This led to the distortion and malfunction of the second SEMS, which worsened the gastric outlet obstruction. For lowering the risk of entanglement, we studied stone extraction balloon-guided repeat SEMS placement. This is the first report of a SEMS entangled by the mesh of the first SEMS and stone extraction balloon-guided repeat SEMS placement for lowering the risk of this complication.

Keywords: Gastric outlet obstruction; Self-expanding metal stent