Endoscopic diagnosis, staging and palliation of malignant gastric outlet obstruction Endoscopic diagnosis, staging and palliation of malignant gastric outlet obstruction
Brief:
Endoscopic diagnosis, staging and palliation of malignant gastric outlet obstruction
Description:
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An 84 yrs old female referred to us for the favor of OGD scopy sos EUS sos Duodenal stenting for a suspected mitotic lesion in the pyloric antrum leading to gastric outlet obstruction.
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A large ulcerostenotic lesion in the pyloric antrum extending upto the pyloric opening
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Scope could be passed with difficulty into the duodenum.
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Multiple biopsies were taken from the lesion for HPE.
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EUS revealed hypoechoic lesion in the antrum which has breached the serosa.
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Few subcentimeter nodes were seen in the peritumorous region. Minimal free fluid was also noted in the perigastric region, suggestive of peritoneal dissemination.
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A 9 cms uncovered pyloroduodenal stent was then placed across the stricture under fluoroscopic control
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Optimal stent deployment was confirmed both on endoscopy and fluoroscopy.
TAKE HOME MESSAGE
As we can see in this case that an advanced mitotic lesion of the antrum leading to gastric outlet obstruction who has comorbidities, nodes and ascites was an ideal indication for one stage procedure of detection, diagnosis, staging and palliation secondary to a malignant gastric adenocarcinoma. Hence with this protocol, patient avoided any further imaging or intervention. Surgical palliation can be avoided with this approach. Recently EUS guided Gastrojejunostomy has been described with a success rate of 90%. Hence, the future of luminal obstruction palliation will be the domain of Endoscopists.
Image:
1.A large ulcerostenotic lesion in the pyloric antrum
2.Scope could be passed with difficulty into the duodenum
3.Multiple biopsies were taken from the lesion for HPE
4.EUS revealed hypoechoic lesion in the antrum which has breached the serosa
5.Minimal free fluid was also noted in the perigastric region.
6.Few subcentimeter nodes were seen in the peritumorous region
7.Optimal stent deployment was confirmed on endoscopy
8.Optimal stent deployment was confirmed on fluoroscopy
Posted by Dr. Vipulroy Rathod
Oct 27, 2016
Categories:
Gastrovision Case Capsules
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