Long-term treatment of an ischemic jejunal stricture: Is stenting a viable option?
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AbstractSmall-bowel strictures can present with variable patterns of obstructive symptoms. Determining the etiology can guide the appropriate management. Anastomotic or postsurgical causes from open abdominal surgeries can increase the risk of occurrence. In the setting of long, complex strictures, surgery is the mainstay of treatment.1 In addition to surgically related adverse events, more than 70% of patients can develop recurrent strictures significantly increasing the risk of malnutrition and short bowel syndrome.2,3 Endoscopic management with balloon dilation has been used in uncomplicated short length (<5 cm) strictures, although there is a risk of perforation.1,3 The fibrostenotic changes around a stricture may be amenable to stenting. Although no fully covered self-expanding metal stents (FCSEMSs) are available for enteral stenting in the United States, biliary and esophageal stents could be repurposed.4, 5, 6, 7 However, their migration rates can be very high; securing them to a percutaneous endoscopic gastrostomy (PEG) tube with a suture can reduce their inward migration.8 We present a case in which we managed a long, ulcerated, ischemic jejunal stricture with an FCSEMS (Video 1, available online at www.giejournal.org).
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/19816