Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6181
Peer-review started: January 10, 2017
First decision: April 21, 2017
Revised: May 23, 2017
Accepted: June 9, 2017
Article in press: June 12, 2017
Published online: September 7, 2017
Processing time: 243 Days and 2.7 Hours
The prognosis of pancreatic cancer remains poor, even after initial surgical therapy. Local recurrence after Whipple’s pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a self-expandable metal stent (SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple’s resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing HotAxios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple’s resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.
Core tip: Malignant recurrence after Whipple’s pancreatico-duodenectomy is frequent and may lead to intestinal obstruction. Endoscopic palliation of the intestinal obstruction is challenging. We present 2 endoscopic techniques: Endoscopic ultrasound-guided creation of a gastrojejunostomy using a fully covered lumen apposing metal stent, and insertion of a self-expandable metal stent by means of the single-balloon overtube-assisted technique under fluoroscopic control.