About the Authors.

IF 5.1 Q1 POLYMER SCIENCE

ACS Macro Letters Pub Date : 2020-08-10 DOI:10.1177/1529100617743455

A. Gangopadhyay

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引用次数: 0

Abstract

A 55-year-old man with a history of multiple gunshot wounds complicated by dense adhesions from several previous episodes of abdominal surgery presented with persistent nausea/vomiting. His past medical history included a chronic enterocutaneous fistula, which had been closed with an atrial septal occluder. Additionally, he had had vomiting due to a duodenal stricture secondary to adhesions and he had undergone endoscopic ultrasound (EUS)-guided gastrojejunostomy with a lumen-apposing metal stent (LAMS). This had been complicated by stent misdeployment that required placement of a second tandem LAMS. The patient had reported improvement in his quality of life after closure of the enterocutaneous fistula and weight gain after undergoing the gastrojejunostomy. However, 6 months later, he developed recurrent nausea/vomiting. During endoscopy, the previously placed 15-mm LAMS had evidence of tissue ingrowth through the eroded plastic covering, which was causing there to be a smaller gastrojejunostomy lumen. The stent was dilated with a 15-mm controlled radial expansion balloon, which permitted the endoscope to be advanced into the small intestine. However, the LAMS could not be removed because of tissue ingrowth. Therefore, argon plasma coagulation (APC) was used to break the mesh of the stent (▶Fig. 1). A 20-mm LAMSwas then deployed across the previous stent under endoscopic and fluoroscopic guidance (▶Video1). The new stent was anchored with a 7-Fr ×15-cm plastic double-pigtail stent. Following placement of the 20-mm LAMS, the patient’s symptoms of nausea and vomiting improved considerably. EUS-guided gastrojejunostomy has previously been shown to be successful for the management of gastric outlet obstruction secondary to benign and malignant disease [1, 2]. Previous studies have utilized LAMS of 10mm and 15mm in diameter. Nonetheless, the smaller diameter can lead to stent obstruction, either by tissue ingrowth or food. With the advent of the 20-mm LAMS, patients can now undergo successful larger diameter gastrojejunostomy. Future studies will be needed to determine whether the larger lumen will improve the overall nutrition and health of these patients. E-Videos

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关于作者。

55岁男性，多处枪伤，既往腹部手术多发粘连，持续恶心/呕吐。他的既往病史包括慢性肠皮瘘，曾用房间隔封堵器封闭。此外，由于粘连引起的十二指肠狭窄，他曾出现呕吐，并接受了超声内镜(EUS)引导下的胃空肠造口术和腔内金属支架(LAMS)。由于支架部署不当，需要放置第二个串联LAMS，这使情况变得复杂。患者报告在肠皮瘘关闭后生活质量改善，并在进行胃空肠吻合术后体重增加。然而，6个月后，他复发性恶心/呕吐。在内窥镜检查中，先前放置的15mm LAMS有组织通过侵蚀的塑料覆盖物向内生长的证据，这导致胃空肠造口管腔变小。支架用15毫米可控径向扩张球囊扩张，使内窥镜进入小肠。然而，由于组织向内生长，LAMS不能被移除。因此，我们采用氩等离子体凝固(APC)来打破支架的网状结构(▶图2)。1).然后在内镜和透视引导下，在先前的支架上放置一个20毫米的lams(▶视频1)。新支架用7-Fr ×15-cm塑料双尾支架固定。放置20毫米LAMS后，患者的恶心和呕吐症状明显改善。eus引导下的胃空肠吻合术在治疗良恶性疾病继发的胃出口梗阻方面已被证明是成功的[1,2]。以前的研究使用了直径为10mm和15mm的LAMS。尽管如此，较小的直径可能会导致支架阻塞，要么是组织向内生长，要么是食物。随着20毫米LAMS的出现，患者现在可以成功地进行更大直径的胃空肠吻合术。未来的研究将需要确定更大的管腔是否会改善这些患者的整体营养和健康。E-Videos

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来源期刊

ACS Macro Letters 化学-

CiteScore

10.40

自引率

3.40%

发文量

209

审稿时长

1 months

期刊介绍： ACS Macro Letters publishes research in all areas of contemporary soft matter science in which macromolecules play a key role, including nanotechnology, self-assembly, supramolecular chemistry, biomaterials, energy generation and storage, and renewable/sustainable materials. Submissions to ACS Macro Letters should justify clearly the rapid disclosure of the key elements of the study. The scope of the journal includes high-impact research of broad interest in all areas of polymer science and engineering, including cross-disciplinary research that interfaces with polymer science. With the launch of ACS Macro Letters, all Communications that were formerly published in Macromolecules and Biomacromolecules will be published as Letters in ACS Macro Letters.