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Duodenal perforation by a Wallstent
V K Thumbe1, A D Houghton, M S Smith
1Dept. of Surgery, Royal Shrewsbury Hospital NHS Trust, UK.
Endoscopy
|June 23, 2000
Summary
Metallic mesh stents offer an alternative to surgery for malignant gastric outlet obstruction. However, a case of Wallstent migration and duodenal perforation highlights potential risks, suggesting design modifications may be necessary.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Oncology
Background:
- Malignant gastric outlet obstruction (GOO) often requires palliative treatment.
- Metallic mesh stents (e.g., Wallstent) are an endoscopic alternative to surgical bypass.
- Stent placement aims to relieve obstruction and improve quality of life.
Observation:
- A patient with advanced malignancy developed gastric outlet obstruction.
- A Wallstent was inserted endoscopically to palliate the obstruction.
- The patient later presented with duodenal perforation due to stent migration.
Findings:
- The metallic mesh stent migrated from its original position.
- The sharp ends of the Wallstent caused a late duodenal perforation.
- This complication raises concerns about the safety and efficacy of Wallstents in GOO.
Implications:
- Current Wallstent design may pose risks of ulceration and perforation.
- Further investigation into stent design modifications is warranted.
- The role of endoscopic stenting versus surgical bypass for malignant GOO needs careful consideration.