[The use of Wallstent in malignant constrictions of the gastrointestinal tract]. / Wallstent alkalmazása a felsó gastrointestinalis rendszer malignus szúkületeiben.

Prosthesis implantation in malignant oesophageal stenosis, postoperative gastric outlet obstruction and jejunal stenosis is a quick and efficient method. The expansile metal stents are a new alternative to conventional plastic prosthesis. The Wallstent is made of surgical steel alloy elements braided in tubular fashion. The Wallstent is delivered in a small diameter device, but it expands to a much larger size after placement than the inner diameter of plastic stent. The small predilatations diameter makes implantation of the Wallstent less prone to cause complications or severe discomfort to the patient. The authors implanted seven Wallstents in six patients. One patient had oesophageal cancer, one ischaemic jejunal stenosis and four jejunal stenosis due to extraluminal tumour recurrences following total gastrectomy for cancer. The authors discuss in detail the usefulness of the Wallstent implantation in two cases with malignant disease of the oesophagus and jejunum. They remained symptoms free for 7 and 10 months after Wallstent implantation until death. Despite their higher initial cost, the metal stents are cost effective because of the absence of early and severe complications and the decrease in the hospitalization.

[Management of postoperative ischemic jejunal stenosis using balloon dilatation and/or Wallstent implant]. / Postoperativ ischaemiás jejunalis stenosis kezelése ballonkatéteres tágítással vagy/és Wallstent implantatióval.

Ischaemic stenosis of the jejunum is rare. For technical, anatomical, and pathological reasons ischemic stenosis of the jejunal segment used for the replacement of the stomach and oesophagus requires a special approach. The present study reports two cases of dilation of ischaemic strictures of the jejunal loop by balloon catheter, used for replacement after oesophagogastrectomy and gastrectomy. In the later case, in which the occlusion of the blood vessels supplying the affected segment was observed right at the level of the aorta, Wallstent was implanted. The advantages and disadvantages of metal stents are discussed and oesophaogoaortic fistula, a rare complication, which appeared a year after Wallstent placement, is described. The two cases presented in this study give evidence that using balloon catheters and implanting Wallstent-in selected cases-may give good results in the management of postoperative ischaemic strictures of the jejunum. The minimally invasive technique with the special indications described here is not known to have been used so far. The rare complication mentioned, however, requires special attention.

Postoperative ischemic jejunal stenosis treated with balloon catheter dilation and Wallstent implantation.

Ischemic stenosis of the jejunum is rare. For technical, anatomical, and pathological reasons, ischemic stenosis of the jejunal segment used for the replacement of the esophagus or the stomach, or both, represents a special entity. The present study reports a case of balloon catheter dilation of ischemic strictures of the jejunal segment, used for substitution after gastrectomy. In this patient, an occlusion of the blood vessels supplying the affected segment was observed at its aortic origin, and a Wallstent was implanted. A rare late complication, aortoesophageal fistula, appeared one year after placement of the Wallstent. The case presented in this study suggests that using balloon catheters and implanting a Wallstent may be a useful approach to the management of postoperative ischemic strictures of the jejunum in selected cases. The minimally invasive technique with special indications used here has not previously been described. The rare complication mentioned, however, requires special attention.