Mouradides C, Taha A, Borbath I, Deprez PH, Moreels TG. How to treat intestinal obstruction due to malignant recurrence after Whipple’s resection for pancreatic head cancer: Description of 2 new endoscopic techniques. World J Gastroenterol 2017; 23(33): 6181-6186 [PMID: 28970734 DOI: 10.3748/wjg.v23.i33.6181]
Corresponding Author of This Article
Tom G Moreels, MD, PhD, Cliniques Universitaires Saint-Luc, Hépato-Gastroentérologie, Avenue Hippocrate 10, B-1200 Brussels, Belgium. tom.moreels@uclouvain.be
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Mouradides C, Taha A, Borbath I, Deprez PH, Moreels TG. How to treat intestinal obstruction due to malignant recurrence after Whipple’s resection for pancreatic head cancer: Description of 2 new endoscopic techniques. World J Gastroenterol 2017; 23(33): 6181-6186 [PMID: 28970734 DOI: 10.3748/wjg.v23.i33.6181]
World J Gastroenterol. Sep 7, 2017; 23(33): 6181-6186 Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6181
How to treat intestinal obstruction due to malignant recurrence after Whipple’s resection for pancreatic head cancer: Description of 2 new endoscopic techniques
Christina Mouradides, Alaa Taha, Ivan Borbath, Pierre H Deprez, Tom G Moreels
Christina Mouradides, Alaa Taha, Ivan Borbath, Pierre H Deprez, Tom G Moreels, Cliniques universitaires Saint-Luc, Hépato-Gastroentérologie, B-1200 Brussels, Belgium
Author contributions: Mouradides C, Taha A, Deprez PH and Moreels TG performed the endoscopic procedures; Borbath I was in charge of the clinical follow-up of the patients; Mouradides C, Taha A and Moreels TG wrote the report; Mouradides C, Taha A, Borbath I, Deprez PH and Moreels TG read and approved the report.
Institutional review board statement: All endoscopic procedures were performed according to good clinical practice standards approved by the Institutional Review Board of the Cliniques universitaires Saint-Luc.
Informed consent statement: Both patients consented to undergo the endoscopic procedures described in the current manuscript.
Conflict-of-interest statement: There is no conflict of interest to be reported for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tom G Moreels, MD, PhD, Cliniques Universitaires Saint-Luc, Hépato-Gastroentérologie, Avenue Hippocrate 10, B-1200 Brussels, Belgium. tom.moreels@uclouvain.be
Telephone: +32-2-7642892 Fax: +32-2-7649197
Received: January 7, 2017 Peer-review started: January 10, 2017 First decision: April 21, 2017 Revised: May 23, 2017 Accepted: June 9, 2017 Article in press: June 12, 2017 Published online: September 7, 2017 Processing time: 243 Days and 2.7 Hours
Abstract
The prognosis of pancreatic cancer remains poor, even after initial surgical therapy. Local recurrence after Whipple’s pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a self-expandable metal stent (SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple’s resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing HotAxios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple’s resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.
Core tip: Malignant recurrence after Whipple’s pancreatico-duodenectomy is frequent and may lead to intestinal obstruction. Endoscopic palliation of the intestinal obstruction is challenging. We present 2 endoscopic techniques: Endoscopic ultrasound-guided creation of a gastrojejunostomy using a fully covered lumen apposing metal stent, and insertion of a self-expandable metal stent by means of the single-balloon overtube-assisted technique under fluoroscopic control.
