CASE REPORT Fluoroscopy-Guided Peroral Placement of a Self-Expandable Metallic Stent for Malignant Jejunal Obstruction in a Non- surgically Altered Stomach Zhe Wang 1,2 • Jung-Hoon Park 1 • Kun Yung Kim 1 • Joonmyeong Choi 1 • Hongtao Hu 1,3 • Nader Bekheet 1,4 • Sung Hwan Yoon 1 • Ho-Young Song 1,5 Received: 23 May 2018 / Accepted: 28 July 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018 Abstract Malignant small bowel obstruction is a common and distressing complication in advanced cancer patients. Recently, stent placement was reported to be a safe and effective alternative treatment. However, there are only a few case reports associated with stent placement in malignant jejunal obstruction. Furthermore, most patients had a history of gastrectomy before stent placement, which shortens the catheterization pathway. In our case series, we present five cases of malignant proximal jejunal obstruc- tion in a non-surgically altered stomach in the management of fluoroscopy-guided self-expandable metallic stent placement and discuss the interventional management and clinical outcomes. Level of Evidence Level 4, Case Series. Keywords Malignant small bowel obstruction Á Self- expandable metallic stent Á Non-surgically altered stomach Á Jejunum Introduction Malignant small bowel obstruction (MSBO) is a common and distressing complication in advanced cancer patients, particularly in those with abdominal tumors [1, 2]. Patients with MSBO usually describe a pattern of gradual worsen- ing of symptoms that include episodes of abdominal cramps, nausea and vomiting, and abdominal distension. Although palliative surgery can alleviate the obstructive symptoms and enable resumption of a diet, it causes high mortality and substantial hospitalization relative to the patient’s remaining survival time [3]. Recently, different types of SEMSs and covered stents have been reported as alternative treatments for MSBO with minimal morbidity [4–7]. Most MSBO patients have a history of gastrectomy before stent placement. Their catheterization pathway shortens after surgery, and a stent delivery system can easily reach the obstruction site of the proximal jejunum. However, it is very difficult to insert a stent delivery sys- tem into the proximal jejunum of patients who have not had such a surgery. We report our experience of five patients with malignant proximal jejunal obstruction in a non-sur- gically altered stomach in the management of fluoroscopy- guided self-expandable metallic stent placement and dis- cuss the interventional management and clinical outcomes. Zhe Wang and Jung-Hoon Park contributed equally to this work. & Ho-Young Song hysong@amc.seoul.kr 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul 05505, Republic of Korea 2 Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District 300052, People’s Republic of China 3 Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou city 450003, Henan Province, China 4 Gastrointestinal Endoscopy and Liver Unit, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt 5 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olymic-ro 43-gil, Songpa- gu, Seoul 05505, Republic of Korea 123 Cardiovasc Intervent Radiol https://doi.org/10.1007/s00270-018-2048-3