Balloon overtube-assisted stenting in difficult upper and lower gastrointestinal locations using a modified over-the-wire technique

In this series of four patients, some modifications of the standard over-the-wire (OTW) technique for stent deployment using the balloon overtube normally used in single-balloon enteroscopy are presented. This modified technique allowed the use of OTW stents in patients where there were difficulties that meant the standard technique was unsuccessful. For each patient, the authors describe different small novel adaptations of this modified technique that enabled self-expanding metal stents (SEMSs) and biodegradable stents to be successfully deployed in different gastrointestinal locations. Moreover, in one patient the stent was placed without fluoroscopic guidance.

• References

• 1 Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001; 344: 1681-1687
• 2 Rejchrt S, Kopacova M, Bartova J et al. Intestinal biodegradable stents. initial experience in the Czech republic. Folia Gastroenterol Hepatol 2009; 7: 7
• 3 Rejchrt S, Kopacova M, Brozik J et al. Biodegradable stents for the treatment of benign stenoses of the small and large intestines. Endoscopy 2011; 43: 911-917
• 4 Ross AS, Semrad C, Waxman I et al. Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction. Gastrointest Endosc 2006; 64: 835-837
• 5 Popa D, Ramesh J, Peter S et al. Small bowel stent-in-stent placement for malignant small bowel obstruction using a balloon-assisted overtube technique. Clin Endosc 2014; 47: 108-111
• 6 Pérez-Cuadrado E, Carballo F, Latorre R et al. An endoscopic technique for treating symptomatic distal jejunum obstruction by leaving the overtube in place. Rev Esp Enferm Dig 2013; 105: 107-109
• 7 Kida A, Matsuda K, Noda Y. Endoscopic metallic stenting by double-balloon enteroscopy and its overtube for malignant gastrointestinal obstruction as palliative treatment. Dig Endosc 2013; 25: 552-553
• 8 Pinho R, Proença L, Alberto L et al. Biliary self-expandable metallic stent using single balloon enteroscopy assisted ERCP-overcoming limitations of current accessories. Rev Esp Enferm Dig 2013; 105: 561-564
• 9 Skinner M, Gutierrez JP, Wilcox CM et al. Overtube-assisted placement of a metal stent into the bile duct of a patient with surgically altered upper-gastrointestinal anatomy during double-balloon enteroscopy-assisted ERCP. Endoscopy 2013; 45 (Suppl. 02) E418-E419
• 10 Neumann H, Wilcox CM, Mönkemüller K. Balloon overtube-assisted placement of self-expanding metal stents. Endoscopy 2013; 45 (Suppl. 02) E369-E370