Iterative evaluation of novel access techniques for small bowel obstruction: combining image guided, percutaneous,...

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Interventional Endoscopy

Background:

• Small bowel obstruction (SBO) often necessitates extensive adhesiolysis, posing significant risks.
• Developing less invasive therapeutic options for SBO is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the feasibility of advanced imaging, percutaneous access, and endoscopy as alternative therapies for SBO.
• To assess the efficacy and safety of novel minimally invasive approaches for managing SBO.

Main Methods:

• Retrospective case series (IDEAL stages 1 and 2a) involving 12 adult patients with chronic SBO.
• Three novel access methods were employed, combining endoscopic, fluoroscopic, and surgical techniques, followed by balloon dilation of stenotic areas.
• Techniques included a purely endoscopic approach, a combined endoscopic and percutaneous approach, and a cut-down approach.

Main Results:

• Procedural success, defined as successful access and balloon dilation, was achieved in 10 of 12 patients (83%).
• No major complications occurred, and conventional operative intervention was avoided in all technically successful cases.
• Median follow-up was 10 months, with SBO recurrence in two patients. Median hospital stay was 4 days.

Conclusions:

• Novel minimally invasive approaches are feasible alternatives to surgery for select SBO patients.
• These techniques demonstrate potential for reducing the need for extensive adhesiolysis.
• Further comparative studies are warranted to refine and validate these novel methods against standard surgical procedures.