Fung Brian M, Chen Formosa C, Tabibian James H
Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States.
Department of Surgery, Olive View-UCLA Medical Center, Sylmar, California, United States.
Endosc Int Open. 2020 Oct;8(10):E1429-E1434. doi: 10.1055/a-1229-4000. Epub 2020 Sep 22.
Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn's disease-associated stricture. In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.
腔内支架置入术安全、有效，有时是缓解胃肠道梗阻的首选方法。然而，当病变无法通过导丝穿过时，支架置入在技术上不可行，这就需要采用更具侵入性的姑息治疗方法和紧急手术干预。在本系列研究中，我们报告了使用透明帽辅助支架置入术来改善胃肠道梗阻段管腔可视化的经验，并挽救那些可能因技术失败而导致的病例。在两例胃十二指肠梗阻和三例结肠梗阻病例中，将一个透明帽（即远端附件）固定在内镜尖端，以利于可视化和支架置入。支架置入的适应证包括恶性梗阻、憩室炎相关梗阻和克罗恩病相关狭窄。在本报告中，我们证明了在具有挑战性的恶性和良性胃十二指肠及结肠梗阻病例中，使用透明帽有助于内镜下支架置入。对于标准技术不成功或一开始就预计技术困难的病例，可以使用用于内镜支架置入的透明帽。解剖结构迂曲或梗阻病变特别狭窄、脆弱或外生性生长的病例可能从这种新颖的技术改进中获益最大。
