Palliative Percutaneous Jejunal Stent for Patients with Short Bowel Syndrome

Abstract

Gastrointestinal obstruction is a common preterminal event in patients with gastric and pancreatic cancer who often undergo palliative bypass surgery. Although endoscopic palliation with self-expandable metallic stents has emerged as a safe and effective alternative to surgery, experience with this technique remains limited. In particular, a proximal jejunal obstruction requires more technical expertise than a duodenal obstruction. Palliative treatment modalities include both surgical and nonsurgical approaches. In this report, we describe the successful placement of self-expandable metallic stents at the proximal jejunum using a combination of percutaneous endoscopic, intraoperative, and transstomal stenting. Usually endoscopy is not indicated in cases of proximal jejunal obstruction, but some cases may require palliative endoscopy instead of bypass operation.

Fig. 1

Percutaneous contrast imaging of small bowel tube demonstrating a proximal jejunal stricture.

Fig. 2

Percutaneous ultrathin endoscopic image showing a covered stent placed at the proximal jejunum stricture.

Fig. 3

Placement of a covered stent at the fistula, which prevented the leakage of digestive secretions. A cholangio-ductal stent can also be seen.