Small-Bowel Strictures Dilation and Stent Placement
Small-bowel strictures are relatively uncommon and can be benign or malignant. Benign strictures are usually related to peptic ulcer disease and nonsteroidal anti-inflammatory agents. Balloon dilation can be performed safely with modest efficacy. Malignant strictures are usually due to pancreatic cancer and obstruction of the second duodenum. Self-expandable metal stents can be placed to relieve obstruction in such patients. Additionally, self-expandable stents can be placed more distally, although this requires the use of colonoscopes or enteroscopes. In this chapter balloon dilation and stent placement of small-bowel strictures will be discussed.
KeywordsSmall bowel Strictures Peptic ulcer Nonsteroidal anti-inflammatory drugs (NSAIDs) Balloon dilation Pancreatic cancer Duodenal obstruction Self-expandable metal stents (SEMS) Stent placement
Placement of expandable metal stent in a patient with prior pyloric sparing Whipple and biliary obstruction. There is downstream obstruction due to recurrent tumor in the afferent limb. The stricture could not be traversed with biliary accessories using an adult colonoscope. The single balloon endoscope was advanced to the lesion and allowed an en face view of the stricture. It was then traversed. A guidewire and catheter were left in place. The adult colonoscope was then loaded over the wire and an enteral stent placed (MPG 54,670 kb)
Placement of a WallFlex stent to open an ileal obstruction. Video courtesy of Louis M. Wong Kee Song, MD, at Mayo, Rochester (WMV 26,123 kb)
Placement of a WallFlex stent to open a gastric outlet obstruction at the ligament of Treitz. Video courtesy of Louis M. Wong Kee Song, MD, at Mayo, Rochester (WMV 10,154 kb)