Transjejunostomy Stent Placement in Patients With Malignant Small-Bowel Obstructions.

Abstract

The objective of our study was to evaluate the clinical effectiveness and safety of transjejunostomy stent placement in patients with malignant small-bowel obstructions (SBOs). Twenty-three patients (age range, 20-81 years) who underwent transjejunostomy stent placement between March 2009 and December 2016 for one (n = 20) or two (n = 3) malignant SBOs from advanced abdominal and pelvic malignancies were included in our study. Percutaneous jejunostomy was created 30-100 cm upstream to malignant SBOs and was immediately followed by stent placement through the jejunostomy stoma during the same session. A retrospective analysis was conducted for technical success, bowel decompression, improvement of obstructive symptoms (3-point scale), improvement of food intake capacity (4-point scale), and procedure-related complications. Stent placement was technically successful in 22 of 23 patients (95.7%). Bowel decompression was confirmed by enterography (n = 21) and CT (n = 16). Obstructive symptoms improved partially (n = 9) or completely (n = 13) within 2 weeks after the procedure. Food intake capacity improved by 3 points in one patient, 2 points in seven patients, and 1 point in 14 patients (p < 0.0001). Major complications (n = 3, 13.0%), including localized peritonitis (n = 2) and bowel perforation (n = 1), were successfully treated conservatively. Transjejunostomy stent placement is an effective treatment in patients with malignant SBOs. It is technically feasible in most patients (95.7%) and provides substantial symptomatic improvement. Procedure-related complications are not rare but can be managed conservatively.