Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7589-7593
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7589
Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine
Kazunari Nakahara, Chiaki Okuse, Nobuyuki Matsumoto, Keigo Suetani, Ryo Morita, Yosuke Michikawa, Shun-ichiro Ozawa, Kosuke Hosoya, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
Kazunari Nakahara, Chiaki Okuse, Nobuyuki Matsumoto, Keigo Suetani, Ryo Morita, Yosuke Michikawa, Shun-ichiro Ozawa, Kosuke Hosoya, Fumio Itoh, Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki 216-8511, Japan
Shinjiro Kobayashi, Takehito Otsubo, Department of Gastroenterogical and General Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Author contributions: Nakahara K, Okuse C and Matsumoto N designed the report; Nakahara K, Suetani K, Morita R, Michikawa Y Ozawa S, Hosoya K and Kobayashi S were attending doctors for the patients; Otsubo T and Itoh F organized the report; and Nakahara K wrote paper.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: Authors declare no conflict of interests for this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazunari Nakahara, PhD, Department of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki 216-8511, Japan. nakahara@marianna-u.ac.jp
Telephone: +81-44-9778111 Fax: +81-44-9765805
Received: November 14, 2014
Peer-review started: November 17, 2014
First decision: December 2, 2014
Revised: December 15, 2014
Accepted: March 18, 2015
Article in press: March 19, 2015
Published online: June 28, 2015
Abstract

We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.

Keywords: Enteral stent, Gastrointestinal obstruction, Balloon enteroscopy, Overtube, Self-expandable metallic stent

Core tip: Self-expandable metallic stent (SEMS) placement in surgically reconstructed intestine is more challenging because of the long length and the bifurcated configuration of the intestine. We present three cases of SEMS placement using a balloon enteroscope and its overtube for malignant obstruction of surgically reconstructed intestine. We consider that the present technique is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.