Self-expandable metal stent placement for XXXX .

@entity1 @entity5 @entity9727 @entity1702 @entity1321 @entity3 @entity356
OBJECTIVE: @entity1702 ( @entity1702 ) are widely used for the palliative management of malignant proximal gastroduodenal obstruction because of its low morbidity and mortality rates compared with surgical bypass. However, stent placement for @entity9727 beyond the first part of the duodenum is considered technically difficult and is not routinely performed. We report our experience with @entity1702 placement for these @entity1 . METHODS: Between 2006 and 2015, 51 @entity1 with unresectable or metastatic malignancy underwent @entity1702 placements under combined endoscopic and fluoroscopic guidance. Eighteen @entity1 had @entity1321 distal to the duodenal bulb. Their demographics, technical and clinical outcomes, periprocedural morbidity and mortality, length of hospital stay, further interventions and overall survival were analysed. RESULTS: Out of the 18 cases, nine cases of @entity1321 were due to primary @entity5 , three due to @entity356 , three from other @entity5 and three were the result of @entity3 . In 12 @entity1 , the obstruction involved the second part (D2), in four the third part (D3) and in two the fourth part (D4) of the duodenum. A front-facing therapeutic gastroscope was used to visualize the duodenum before the stricture was crossed under direct vision and fluoroscopic guidance, with a catheter and guidewire, and a through-the-scope @entity1702 deployed using an 'over-the-wire' technique. Technical success rate was 89%. The mean gastric outlet obstruction scores improved from 0.63 to 2.57 (P<0.0001). Four @entity1 died within 30 days of the procedure, although none of the deaths were procedure related. The median length of postprocedural hospital stay was 4 days and the median overall survival was 58 days.
