We describe the use of an “oblique” view scope in the successful management of an
eccentric colonic stricture. A 69-year-old woman with a history of uterine leiomyosarcoma
treated by hysterectomy, radiotherapy, and sigmoid resection was referred because
of a colon stricture. A recent positron emission tomography (PET) scan showed an area
of abnormal uptake in the descending colon. Colonoscopy was not successful in traversing
a stricture in the left colon. The patient was referred for a repeat attempt. During
our examination, it was not possible to pass a pediatric colonoscope or an upper endoscope
through a stricture located 35 cm from the anal verge ([Fig. 1]). Attempts to pass a biliary guide wire with a hydrophilic tip using a sphincterotome
were also unsuccessful. Therefore, a prototype upper scope with an oblique-viewing
angle (EG-3670QK, Pentax Precision Instruments, Orangeburg, New York, USA) was used
to visualize the stricture “en face.” In addition, the elevator that was available
allowed manipulation of the sphincterotome and wire to give access beyond the stricture
([Fig. 2]). The stricture was dilated with balloons. Following dilation, a pediatric colonoscope
was passed, allowing full examination and biopsy of the stricture area. Pathological
findings were consistent with a radiation stricture.
Fig. 1 Eccentric view of the stricture with the pediatric colonoscope.
Fig. 2 View of the stricture with the oblique-viewing upper scope. A sphincterotome was passed
over the wire into the stricture.
The oblique-viewing endoscope combines features of both end- and side-viewing endoscopes
([Fig. 3]). The scope has a 125-cm working length, a shaft diameter of 13.7 mm and a 120-degree
field of view with a 60-degree oblique viewing angle. It has a large working channel
(3.8 mm) and an elevator, allowing the use of a variety of accessories.
Fig. 3 Prototype upper scope with an oblique-viewing angle.
This scope has proved to be useful during endoscopic retrograde cholangiopancreatography
(ERCP) in patients with surgically altered gastrointestinal anatomy [1]. A recent abstract suggested that the oblique-view scope could help in a variety
of endoscopic procedures [2]. This is the first report of the use of an oblique-viewing upper endoscope in the
management of a difficult colonic stricture.
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