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Case Reports
. 2010 Jun 28;16(24):3087-90.
doi: 10.3748/wjg.v16.i24.3087.

Stone extraction balloon-guided repeat self-expanding metal stent placement

Hyung Hun Kim  1 , Jeong Seop Moon, Soo Hyung Ryu, Jung Hwan Lee, You Sun Kim
Affiliations
Case Reports

Stone extraction balloon-guided repeat self-expanding metal stent placement

Hyung Hun Kim et al. World J Gastroenterol. .

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.

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Figures

Figure 1
Figure 1
Plain film of the abdomen seven days after deploying the second self-expanding metal stent (SEMS). The unexpanded part of the second SEMS due to entanglement (arrows).
Figure 2
Figure 2
Fluoroscopy. The stone extraction balloon (arrow) was advanced distal to the existing SEMS.
Figure 3
Figure 3
Duodenoscopy. A: The stone extraction balloon advancing over the region of tumor ingrowth; B: The guidewire advancing through the stone extraction balloon; C: The expanded covered SEMS.
Figure 4
Figure 4
Plain film of the abdomen seven days after replacement of the SEMS. The fully expanded second SEMS overlapping the first SEMS without entanglement (arrow).
See this image and copyright information in PMC

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