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Monica GUALTIEROTTI


Parma, Italy
MD
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Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.
Surgical intervention
10 years ago
2375 views
7 likes
0 comments
04:28
Endoscopic metal stenting of common bile duct for unresectable pancreatic cancer
Obstructive jaundice occurs in many patients with unresectable pancreatic cancer.
Endoscopic therapy is the best palliative option for inoperable pancreatic cancers, either for the treatment of a potential duodenal stenosis or, in the majority of cases, for the treatment of the associated jaundice.
Metal stents are preferable to plastic stents in patients who have a life expectancy of more than 3 months. The obstruction of the common bile duct is due to cancer of the head of the pancreas that compresses the biliary tree. However, in a few cases, the mucosa of the ampulla is also involved with malignancy from the adjacent pancreas.
We present the case of two patients with unresectable pancreatic cancer, obstructive jaundice and pruritus, in which the drainage of the common bile duct was achieved with an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with insertion of an uncovered metal stent (Wallflex® type) with subsequent relief of the jaundice.
Endoscopic drainage of the common bile duct for obstructive jaundice for unresectable pancreatic cancer is the preferred palliative approach in this type of patient.
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.
Surgical intervention
10 years ago
1554 views
29 likes
0 comments
04:57
Endoscopic treatment of esophagojejunostomy dehiscence after total gastrectomy with a fully covered self-expandable metallic stent
The most frequent complications after upper GI surgery are leaks and stenosis. These complications are associated with significant morbidity and mortality rates.
Conservative treatments such as Self-Expanding Metal Stents (SEMS) and balloon dilatation have been described for the treatment of these complications, but stay controversial yet.
We report a case of a 66-year-old woman who underwent a total gastrectomy for a neuro-endocrine tumor that developed an anastomotic dehiscence six days after surgery, successfully treated with a covered SEMS. The stent was well-tolerated and left in place for two weeks. Its ablation confirmed through endoscopic and enhanced X-ray upper series the development of a granulation tissue, along with epithelial proliferation, enough to produce a perfectly closed and healing anastomotic defect. No further surgery was required; oral feeding was started and has been well-tolerated and the patient was soon discharged.
In this case where the use of surgery seemed inevitable and not risk-free, the placement of a removable SEMS was demonstrated to be a safe and efficient technique.