BACKGROUND: Endoscopic self-expandable metal stent (SEMS) insertions for palliation of malignant biliary and duodenal obstructions have been revealed to be an effective treatment. We present our clinical experience with the use of SEMS for malignant biliary and duodenal obstructions caused by periampullary cancer. METHODS: We performed a retrospective review of all patients who underwent endoscopic biliary and duodenal SEMS insertion for palliation of malignant biliary and duodenal obstruction caused by periampullary cancer between July 2007 and October 2016. The patients received simultaneous or sequential endoscopic biliary stenting and duodenal stenting with COMVITM stents (partially covered; Taewoong, Seoul, Korea). RESULTS: The final diagnoses of our enrolled patients were 15 pancreas head cancer, and 3 distal common bile duct (CBD) cancer. The main stricture site in the duodenum was bulb (n = 4, 22.2%), 2nd portion (n = 9, 50.0%), and 3rd portion (n = 5, 27.8%). The technical success rates of CBD and duodenal stenting were 100% (18/18), and 100% (18/18), respectively. The clinical success rates of CBD and duodenal stenting were 100% (18/18), and 88.9% (16/18), respectively. Median actuarial stent patency for biliary and duodenal SEMS were 6.5 months (range, 1-2 months) and 4.5 months (range, 1-14 months), respectively. Three patients (16.7%) had recurrent biliary obstruction and all of them underwent percutaneous trans-hepatic biliary drainage (PTBD) with biliary SEMS reinsertion. Three other patients (16.7%, totally different from patients with CBD restenosis) had recurrent duodenal obstruction and all of them underwent upper gastrointestinal endoscopy with duodenal SEMS reinsertion. CONCLUSION: Endoscopic SEMS insertions for simultaneous palliation of malignant biliary and duodenal obstruction in patients with periampullary cancer may provide a safe, and less invasive alternative to surgical palliation with a successful clinical outcome.
Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Drainage ; Duodenal Obstruction ; Duodenum ; Endoscopy, Gastrointestinal ; Head and Neck Neoplasms ; Humans ; Palliative Care* ; Pancreas ; Retrospective Studies ; Self Expandable Metallic Stents ; Seoul ; Stents*

Chronic pancreatitis is characterized by the progressive inflammation and irreversible fibrosis of pancreas causing pancreatic dysfunctions and various complications. The most common symptom is abdominal pain. In addition various complications such as pseudocyst, biliary or duodenal obstruction, pancreatic ascites, splenic vein thrombosis and pseudoaneurysm can develop according to the degree of inflammation or the progression of disease. So, management of chronic pancreatitis needs multidisciplinary approach in many cases. The treatment method can be divided into life style modifications, medications, endoscopic or radiological interventions and surgeries. In most cases, the specific treatments are recommended not only by the evidence-based guidelines but also by the experts' opinions due to the lack of randomized controlled trials with sufficient number of patients. Life style modifications and medication for the pain and the pancreatic exocrine insufficiency will be addressed in this section.
Abdominal Pain ; Aneurysm, False ; Ascites ; Duodenal Obstruction ; Fibrosis ; Humans ; Inflammation ; Life Style ; Methods ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Splenic Vein ; Thrombosis

Duodenal loop obstruction is an unusual cause of acute pancreatitis. Increased intraluminal pressure hinders pancreatic flow, causing dilatation of the pancreatic duct and inducing acute pancreatitis. We experienced three cases of acute pancreatitis that resulted from duodenal loop obstruction after (1) an esophagectomy with gastric pull-up procedure for esophageal cancer, (2) a gastrectomy with Billroth I reconstruction for gastric cancer, and (3) a gastrojejunostomy for abdominal trauma. An abdominal CT scan revealed a distended duodenal loop, dilated pancreatic duct, and inflamed pancreas with fluid collection. Acute pancreatitis with duodenal loop obstruction was diagnosed by abdominal pain, elevated serum amylase/lipase, and abdominal CT findings. Immediate decompression with a nasogastric tube was performed, and all patients showed improvement within one week after admission. Each patient was followed up for more than two years without recurrence. Our findings suggest the usefulness of nasogastric tube decompression as the first line of treatment for acute pancreatitis related to duodenal loop obstruction.
Abdominal Pain ; Decompression ; Dilatation ; Duodenal Obstruction ; Esophageal Neoplasms ; Esophagectomy ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy ; Humans ; Pancreas ; Pancreatic Ducts ; Pancreatitis* ; Recurrence ; Stomach Neoplasms ; Tomography, X-Ray Computed

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.
Adipocytes ; Adult ; Brunner Glands ; Duodenal Obstruction ; Duodenum ; Endoscopy, Digestive System ; Hamartoma* ; Hemorrhage* ; Humans ; Muscle Cells ; Ulcer

This review article presents the radiological options for management of malignant gastric outflow obstruction distal to the pylorus. We place these options in context with surgical and endoscopic alternatives and recommend their use, particularly in those institutions where endoscopic alternatives may not be readily available.
Duodenal Obstruction ; Pylorus* ; Self Expandable Metallic Stents ; Technology, Radiologic

Malignant gastric outlet obstruction describes a constellation of symptoms that can result as a common endpoint from a variety of primary tumours, particularly those of the upper gastrointestinal tract and pancreas. Affected patients face a dismal, undignified and rapid decline in health secondary to malnutrition, dehydration and constant nausea with associated vomiting. Palliative treatment has traditionally involved a gastrojejunostomy—a major undertaking given the functional status of these patients. More recent advances in the endoscopic placement of metal stents to relieve obstruction have clear benefits over the surgical method. We look at the factors involved in patient selection, the techniques and considerations involved in stent deployment and the potential complications associated with this method.
Dehydration ; Duodenal Neoplasms ; Endoscopy ; Gastric Outlet Obstruction ; Humans ; Malnutrition ; Methods ; Mortuary Practice ; Nausea ; Palliative Care ; Pancreas ; Patient Selection ; Stents ; Upper Gastrointestinal Tract ; Vomiting

Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percutaneous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.
Abdominal Pain ; Aorta, Abdominal ; Duodenal Obstruction ; Duodenum ; Enteral Nutrition ; Gastric Bypass* ; Gastrointestinal Diseases ; Mesenteric Artery, Superior* ; Nausea ; Superior Mesenteric Artery Syndrome* ; Vomiting

Pancreatic cancer tends to be delayed in diagnosis because of the lack of early symptom and less than 20% of patients present with resectable masses. A 95-year-old male visited due to recurrent abdominal pain and vomiting. About 2 years ago, a polypoid lesion was detected at the post-bulbar area on esophagogastroduodenoscopy for medical check-up. Endoscopic biopsy noted chronic inflammation with glandular atypia. On the CT scan, there was an intraluminal polypoid mass lesion with mixed hypodensity at the duodenal second portion. Ultrasound guided biopsy targeting the hypodense lesion was performed and revealed chronic pancreatitis. The vomiting persisted and the patient received a palliative gastrojejunostomy. Twenty-five days after gastrojejunostomy, jaundice occurred and an ill-defined mass at the pancreas head was noted on the CT. Pylorus preserving pancreatoduodenectomy was performed and a 3.5 cm sized, moderate to poorly differentiated ductal adenocarcinoma of pancreas head was diagnosed. Nineteen days after operation, the patient was discharged in good condition.
Abdominal Pain ; Adenocarcinoma ; Biopsy ; Diagnosis ; Duodenal Obstruction* ; Endoscopy, Digestive System ; Gastric Bypass ; Head ; Humans ; Inflammation ; Jaundice ; Male ; Pancreas ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Pylorus ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

No abstract available.
Adult ; Biopsy ; *Brunner Glands/pathology/surgery ; Duodenal Diseases/*complications/diagnosis/surgery ; Duodenal Obstruction/diagnosis/*etiology/surgery ; Duodenoscopy ; Gastric Outlet Obstruction/diagnosis/*etiology/surgery ; Hamartoma/*complications/diagnosis/surgery ; Humans ; Male ; Tomography, X-Ray Computed ; Treatment Outcome

Congenital duodenal obstruction is a rare cause of neonatal intestinal obstruction caused by various intrinsic and extrinsic congenital lesions. Annular pancreas is one of the causes of extrinsic duodenal obstruction and a duodenal web is one of the causes of intrinsic duodenal obstruction. The simultaneous occurrence of an extrinsic and intrinsic pathology is rare. Only four such cases have been reported in literature. We present a similar case of male neonate with partial duodenal obstruction caused by annular pancreas and an intrinsic duodenal web.
Duodenal Obstruction* ; Humans ; Infant, Newborn ; Intestinal Obstruction ; Male ; Pancreas* ; Pathology