Chamely Elias A, Hoang Bryan, Jafri Nadim S, Felinski Melissa M, Bajwa Kulvinder S, Walker Peter A, Barge Jaideep, Wilson Erik B, Cen Putao, Shah Shinil K
Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.
Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX.
CRSLS. 2022 Feb 25;9(1). doi: 10.4293/CRSLS.2021.00094. eCollection 2022 Jan-Mar.
Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.
A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying.
In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.
前肠胃肠道恶性肿瘤继发的胃出口梗阻可通过多种医学、内镜和手术方法进行处理。腹腔镜胃空肠吻合术是那些能够耐受手术的患者的一种长期姑息治疗选择。该手术可能会伴有一些严重的术后技术和非技术并发症，包括胃排空延迟。本文描述了一种我们提出的无切口内镜治疗方法，可用于挽救功能受阻的胃空肠吻合术。
一名57岁男性患者有胰腺腺癌病史，导致胃出口梗阻，在外院接受了先前实施的外科胃空肠吻合术。他的手术因吻合口漏而复杂化，并且由于胃排空延迟基本上持续存在梗阻症状。尽管他的吻合口明显通畅，但这些症状被认为是胃空肠吻合处功能性梗阻所致。在反复检查和多次治疗这些症状失败后，他最终接受了内镜下将未覆盖的结肠支架置入胃空肠吻合术的输出袢。这使得胃内容物能够优先通过输出袢引流，改善了他的胃排空延迟。
在一组特定的晚期前肠恶性肿瘤且再次手术风险高的患者中，挽救性内镜支架置入术可能有助于缓解功能性梗阻性胃空肠吻合术的症状。
