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Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

Korean Journal of Radiology 2021년 22권 5호 p.742 ~ 750
최원석, 윤창진, 이재환,
소속 상세정보
최원석 ( Choi Won-Seok ) - Seoul National University Bundang Hospital Department of Radiology
윤창진 ( Yoon Chang-Jin ) - Seoul National University Bundang Hospital Department of Radiology
이재환 ( Lee Jae-Hwan ) - Seoul National University Bundang Hospital Department of Radiology

Abstract


Objective: To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy.

Materials and Methods: Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated.

Results: The stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively.

Conclusion: Percutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.

키워드

Percutaneous transhepatic enteral stent; Surgically altered bowel anatomy, Recurrent malignant obstruction; Self-expandable metal stent; Afferent loop syndrome, Pancreaticoduodenectomy

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