Relieving Bowel Obstruction with EUS and Stenting
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Abstract
A 61-year-old female with post-Whipple obstruction was treated successfully with EUS-guided stenting, resulting in rapid symptom relief and discharge. Using Endoscopic Ultrasound (EUS), a trans-gastric Self-Expanding Metal Stent (SEMS) was placed between the stomach and pancreatico-biliary roux limb, facilitating immediate drainage and symptom resolution.
MBO affects up to 15% of patients with cancer recurrence following Whipple's procedure. Meta-analyses assessing the outcomes of resectional/bypass palliative surgery for MBO demonstrate that re-obstruction rates are high (almost 50%) and morbidity and mortality are common (up to 90% and 40%, respectively).
However, more recent studies have demonstrated 90-100% success rates for EUS and stenting for relief of malignant biliary obstruction via choledochoduodenostomy and hepaticogastrostomy. Specialist centres have also described placement of gastroenterostomy stents to relieve malignant gastric outflow obstruction.
We propose considering EUS and stenting within the treatment algorithm of MBO patients with suitable anatomy.
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