Endoscopic treatment of neoplastic enteral obstruction by means of self-expanding metal stents.

BACKGROUND: Neoplastic gastroduodenal inoperable stenosis require a palliative treatment to restore alimentary transit. OBJECTIVE: Our purpose was to treat neoplastic gastroduodenal stenosis with self-expanding enteral stents. MATERIAL OF STUDY: An endoscopic treatment with uncovered self-expanding metal stents has been performed in 45 patients: 37 duodenal stenosis (34 pancreatic neoplasia, 1 gallbladder neoplasia, 2 peritoneal carcinosis), 5 anthropyloric neoplastic stenosis and 3 gastro-jejunal anastomosis stenosis were treated. A total of 47 metal stent were positioned: in 43 patient 1 stent; in 2 patient, with a long stenosis, 2 stents. MAIN OUTCOME MEASUREMENT: Efficacy of endoscopic treatment to restore alimentary transit. RESULTS: The positioning was successfull in all cases without any complication. All patients had a rapid and satisfying recovery from symptoms connected to the obstruction. The hospitalization period was averagely 3 days (range 1-7). In one patient another stent was inserted 2 months later because of tunoral ingrowth. The median survival period was 4 months (range 1-5). In one patient with duodenal stenosis due to pancreatic neoplasia,in which were inserted 2 stents, distal one dislocated in the jejunum 3 months later. It was removed by surgery. CONCLUSIONS: The endoscopic stenting is a valid treatment of inoperable gastric duodenal stenosis and may become the preferable option for the palliative treatment of this pathology. KEY WORDS: Endoscopy, Gastroduodenal, Neoplasia, Obstruction, Stent.

Double guidewire technique for ERCP in difficult bile cannulation: experience with 121 cases.

AIM: The aim of this study is to report our experience using double guide-wire technique (DGT) for biliary cannulation. MATERIAL OF STUDY: From 2007 to 2010, out of 1607 consecutive patients undergoing ERCP with the intent to cannulate the common bile duct (CBD) 1335 were considered suitable for this study. In 131 of these patients deep biliary cannulation with standard cannulation technique (SCT) failed. In these cases DGT was attempted. RESULTS: DGT could be used in 121 patients with success rate of deep biliary cannulation in 117 (96.7%) with a 2.6% rate post ERCP pancreatitis. DISCUSSION: Since difficulties in selective cannulation are sometimes encountered due to anatomical constraints or papillary spasm, pharmacologic aids and other non invasive methods such as papillotome cannulation or guidewire cannulation are used. DGT consented a high rate of successful selective biliary cannulation with a low rate of complications. CONCLUSION: According to our experience we can concluded, that in expert hands, the double guidewire technique (DGT) can be considered useful and safe method in difficult biliary cannulation, reducing the need of more invasive technique such as precut papillotomy.

Detection of a suspected bronchobiliary fistula by hepatobiliary scintigraphy.

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.