Endoscopic palliative treatment using SEMS

SafatleRebeiro_headshotAdriana Vaz Safatle-Ribeiro, MD, PhD, from the Cancer Institute of São Paulo, University of São Paulo, São Paulo, Brazil presents this video case “Endoscopic palliative treatment using a metallic stent in a patient with an obstructive jejunal metastasis.”

The video demonstrates the insertion and deployment of an uncovered self-expandable metal stent at the midjejunum in a 42-year-old man receiving palliative treatment for lung cancer, who presented with intestinal subocclusion due to metastatic lesions.

Briefly, endoscopy showed a large volume of liquid stasis and metastatic gastric lesion. Computed tomography revealed jejunal intussusception. Single-balloon endoscopy demonstrated multiple metastatic lesions throughout the small bowel. At the midjejunum level, a 5-cm tumoral mass was found, which partially prevented the endoscope transposition. After demarcation with clips, and removal of the enteroscope, with the overtube in place, an uncovered self-expandable metal stent (22 mm × 9 cm, Wallflex duodenal stent, Boston Scientific, Natick, Mass) was deployed under fluoroscopy. On endoscopic revision, immediate expansion of the stent was confirmed with a contrast-free flow through the lumen. In the following days, the patient was able to consume an oral diet and had normal bowel movements.

With the development of deep enteroscopy and the use of stent deployment through the overtube, patients with small-bowel neoplasia unreachable by conventional endoscopes have become eligible for endoscopic palliation.

The feasibility of palliative therapeutic intervention through balloon-assisted enteroscopy.

This palliative intervention allows better quality of life in an oncologic patient.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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