Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Malignant gastroduodenal로 인한 Gastric outlet
obstruction에 separate gastroduodenal stent
insertion의 유용성에 관한 고찰
화순전남대학교병원 영상의학과 혈관조영 & 인터벤션실
*김종학,
김현석, 최연상, 박 혁, 김종덕, 김경묵, 선종백
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Introduction
 Gastric outlet obstruction
 Common clinical manifestation in benign or malignant
disease of distal stomach, duodenum, and pancreatic
area
 Cause
- Gastric and pancreatic carcinoma
- Lymphoma
- Biliary cancer
- Metastasis to duodenum or jejunum
- Extrinsic compression
 Clinical Presentation
- Nausea, Vomiting, Malnutrition
 “Food fear”
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Introduction
 Malignant Gastroduodenal obstruction
 Average survival time : 3~4 months
 Minimally invasive but effective palliation method
is required
 Surgical palliation
- Standard palliation method
- Associated with high complication rate
; Poor general condition, Malnutrition state
 Stent insertion
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Introduction
 Gastroduodenal Stent
 1992, Gastroduodenal stent – Bare stent
- tumor ingrowth, gronulation tissue formation
 Restricture
 1999, Covered gastorguodenal stent
- Migration(21~26%), biliary obstruction
 Self-expanding separate gastroduodenal stent
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Indications
 Gastroduodenal Stent
 Gastric, duodenal, and proximal jejunal malignant
obstructions caused by non-resectable tumors
 Obstruction by recurred lesion after previous surgical
anastomosis
 Benign obstruction patient with surgical risk
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Technique
 UGI
- Useful for identifying length and location of stricture
 CT
- Tumor staging
- Provide valuable information concerning location of
stricture and possible additional level of obstruction
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 1
¶ 남 / 77
¶ 임상소견: No water and food
¶ 진 단 명 : Malignant stomach
- Gastroduodenal obstruction
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 1
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 1
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 1
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 1
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
¶ 남 / 70
¶ 임상소견: No water and food, vomiting
¶ 진 단 명: Gastric cancer-chemotherapy
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Case 2
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Consideration
• we could know that patient inserted separate
gastroduodenal stent could take ingestper oral by
removing gastric oulet obstruction, recovered solwly
and gained in weight.
• Recently endoscopic self-expanding stent has been
attempted, but in gastric outlet obstruction disease, we
could know that this procedure itself was not achieved
because endoscopic approach was difficult.
Angiography & Intervention
Malignant gastroduodenal로 인한 Gastric outlet obstruction에 separate gastroduodenal stent insertion의 유용성에 관한 고찰
Conclusion
 Separate gastroduodenal stent placement is
very safe and effective palliation method in
patients with unresectable malignant tumors
causing gastric outlet obstruction
- High technical success rate
- Less invasive
- More cost effective than surgical prcedure
Angiography & Intervention