Plastic biliary endoprostheses were originally used to obtain a non-surgical biliary bypass, but complications including occlusion and migration diminished the enthusiasm for their use in malignant biliary tract obstructions. Several reports suggest that the large diameter of self-expandable metallic stents could overcome the problem of stent occlusion, lowering the cost of treatment from repeated endoscopic therapy and hospitalization. We describe a new method of bridge overstent, through an echo guided choledochoduodenostomy, for the management of a metal biliary stent occluded by tumor overgrowth after proximal migration. A year-old man with metastatic pancreatic cancer was previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed pruritus, jaundice and symptoms of gastric outlet obstruction that needed suspension of palliative chemotherapy. A new ERCP was attempted, but endoscopic examination confirmed obstruction of the second part of the duodenum, including the area of the ampulla, due to diffuse tumor growth after proximal migration.
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Terapia paliativa para cáncer de vesícula biliar
Endoscopic techniques for gastrointestinal stenting: When and how to stent, how to manage complications, stent selection and costs. El uso de stents en todo el tracto gastrointestinal ha evolucionado a lo largo del siglo pasado. Over the past century the use of stents has evolved to the point where they are no used throughout the gastrointestinal tract. The evolution of endoscopic ultrasound and signifi cant improvements in stent design have allowed endoscopists to drive the use of gastroenterological stents in new directions.
Use of fully covered self-expanding metal stents for the management of benign biliary conditions. Taberna Arana 2 , C. Reyes Guevara 1 , M. Hospital Virgen de la Luz.