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DOI: 10.1055/a-2291-9315
A radiation-free novel approach for intestinal stent placement: the “scope-in-scope” technique
Supported by: Natural Science Foundation of Fujian Province 2021J01388Supported by: Fujian Medical University 2022QH1299
An elderly woman with persistent abdominal pain and bloating was diagnosed with obstructive sigmoid colon cancer on computed tomography (CT) ([Fig. 1]). Because of a low oxygen saturation value caused by secondary aspiration pneumonia she was admitted to the intensive care unit; therefore transfer to a fluoroscopy-equipped operating room was inappropriate.
After multidisciplinary discussions, colonic stent placement was decided upon, using the “scope-in-scope” technique that combines digital single-operator cholangioscopy with colonoscopy. The colonoscope was used to approach the sigmoid colon, where an infiltrative mass was causing luminal narrowing ([Fig. 2]). Then the cholangioscope (9-Fr, EyeMax; Micro-Tech, Nanjing, China) was inserted directly through the colonoscope biopsy channel.
The forward direction of the cholangioscope can be flexibly adjusted using the operating unit ([Video 1]) and narrow lumens can be navigated under direct visualization. Thus clear observation of the internal structure of the colonic tumor was possible ([Fig. 3]). The cholangioscope was advanced accompanied by irrigation with saline. Passage beyond the obstructed segment was confirmed when dilated intestinal lumen was seen ([Fig. 4]).
Quality:
A 0.035-inch guidewire was inserted through the forceps channel of the cholangioscope and positioned on the oral side of the tumor. The guidewire was maintained in this position as the cholangioscope was withdrawn, measuring the length of the tumor for stent selection. Guided by the wire and direct visualization, an uncoated metal intestinal stent (25 mm diameter, 9 cm length; Boston Scientific) was gradually deployed. It was possible to introduce the cholangioscope into the lumen of the incompletely expanded stent, to ensure that the stent extended beyond both ends of the narrowed segment ([Fig. 5]).
Postoperatively, the patient experienced significant relief from abdominal pain and bloating, bowel movements were successfully resumed, and no complications such as bleeding or perforation were encountered.
Traditional procedures for endoscopic stent placement [1] may lead to radiation exposure for both doctors and patients. This new method is particularly beneficial for certain groups, such as pregnant women, children, and patients with fragile constitutions. The “scope-in-scope” method described above, akin to its application in the appendiceal cavity [2], uniquely allows direct observation and treatment for colonic obstructions and may reduce the risk of perforation and bleeding.
It presents a safer and more efficient alternative for stent placement in patients for whom fluoroscopy is undesirable or at institutions lacking fluoroscopic equipment.
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Publication History
Article published online:
09 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 van Hooft JE, van Halsema EE, Vanbiervliet G. et al. European Society of Gastrointestinal Endoscopy. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2014; 46: 990-1053 DOI: 10.1016/j.gie.2014.09.018. (PMID: 25436393)
- 2 Kong LJ, Liu D, Zhang JY. et al. Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy. Endoscopy 2022; 54: 396-400 DOI: 10.1055/a-1490-0434. (PMID: 33893629)