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A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases.
However, colonic stent placement for tumors close to the anal verge is challenging because of the likelihood of severe pain resulting from the close proximity to the dentate line.
Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
Herein, we describe the use of the newly developed proximal release–type colonic stent for malignant lower rectal obstruction close to the anal verge. This new stent is 22 mm in diameter, 70 mm in length, and mounted on a 16F delivery system. It has flares at both ends to prevent migration. The stent has a closed-cell design and is foreshortened by 30%. It is inserted with the over-the-wire technique (Figs. 1 and 2).
Figure 1The newly developed proximal release–type colonic stent.
A 64-year-old man experiencing nausea and vomiting secondary to a malignant lower rectal obstruction caused by gastric cancer metastasis was referred to our center. A conventional colonic stent was technically difficult to deploy because the lesion was located 2 cm from the anal verge. To palliate this obstruction, we used the newly developed stent (Video 1, available online at www.VideoGIE.org).
We first examined the tumor using an ultraslim endoscope (Fig. 3). Gastrografin fluoroscopy revealed the stenosis length to be 4 cm (Fig. 4). The endoscope was then advanced through the stenosis to the oral side of the tumor, and a guidewire was placed across the stricture through the scope. The stent was inserted using the over-the-wire technique and released gently from the anal side while appropriate positioning was maintained under endoscopic view. The distal edge of the stent was kept at the distal tumor edge to facilitate positioning of the stent close to the anal verge. Finally, the stent was successfully deployed to the appropriate position (Fig. 5A and B). No adverse events, including pain, occurred, and oral intake was started 3 days after the procedure. The patient was discharged 8 days postprocedure.
Figure 3Colonoscopy indicated the tumor to be located 2 cm from the anal verge.
The newly developed proximal release–type colonic stent was inserted using the over-the-wire technique and released gently from the anal side while appropriate positioning was maintained under endoscopic view. The distal edge of the stent was kept at the distal tumor edge to facilitate positioning of the stent close to the anal verge.
References
Saida Y.
Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature.
A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases.
Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
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