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Fluoroscopically Guided Placement of a Covered Self-Expandable Metallic Stent for Malignant Antroduodenal Obstructions

Preliminary Results in 18 Patients

Jun Yong Jeong1,2, Joon Koo Han, Ah Young Kim, Kyoung Ho Lee, Jae Young Lee, Joon-Won Kang, Tae Jung Kim, Shang Hoon Shin and Byung Ihn Choi

1 All authors: Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
2 All authors: Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.



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  		Fig. 1. —Photographs shows polyurethane-covered Niti-S (TaeWoong Medical, Seoul, Korea) stent before deployment with delivery system (top) and after deployment (bottom).

 


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  		Fig. 2A. —47-year-old man with gastric carcinoma involving duodenum. Anteroposterior radiograph obtained during stent placement shows diffuse antroduodenal narrowing (arrows). Contrast media was injected through 5-French catheter. Percutaneous biliary drainage catheter is also noted.

 


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  		Fig. 2B. —47-year-old man with gastric carcinoma involving duodenum. Anteroposterior upper gastrointestinal radiograph obtained 1 day later shows good passage of contrast media.

 


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  		Fig. 3A. —63-year-old woman with gallbladder carcinoma invading antrum and duodenum. Anteroposterior upper gastrointestinal radiograph obtained before stent placement shows total obstruction of gastric outlet with food materials in distended stomach.

 


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  		Fig. 3B. —63-year-old woman with gallbladder carcinoma invading antrum and duodenum. Anteroposterior upper gastrointestinal radiograph shows well-positioned stent 1 day after stent placement.

 


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  		Fig. 3C. —63-year-old woman with gallbladder carcinoma invading antrum and duodenum. Right anterior oblique upper gastrointestinal radiograph shows good barium flow immediately after placement of second covered stent (2 weeks after initial procedure). Initial covered stent migrated proximally into gastric lumen (arrow). Endoscopic removal of stent failed and remained inside patient's stomach until her death without causing symptoms.

 


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  		Fig. 3D. —63-year-old woman with gallbladder carcinoma invading antrum and duodenum. Follow-up conventional radiograph shows that patent lumen of second stent is established.

 


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  		Fig. 4A. —63-year-old woman with advanced gastric carcinoma involving antrum and pylorus. Left anterior oblique upper gastrointestinal radiograph obtained before stent placement shows nearly total obstruction of antrum of stomach. Although guidewire and catheter could pass beyond stricture, stent delivery device could not follow peroral route because of markedly distended J-shaped stomach.

 


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  		Fig. 4B. —63-year-old woman with advanced gastric carcinoma involving antrum and pylorus. Right anterior oblique upper gastrointestinal radiograph shows good barium passage 1 day after stent placement. Stent was placed through percutaneous gastrostomy made in gastric body.

 


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  		Fig. 4C. —63-year-old woman with advanced gastric carcinoma involving antrum and pylorus. Anteroposterior upper gastrointestinal radiograph obtained 64 weeks later shows collapsed stent with recurrent obstruction.

 

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