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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1429-E1434
DOI: 10.1055/a-1229-4000
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Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction

Brian M. Fung
1   Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States
,
Formosa C. Chen
2   Department of Surgery, Olive View-UCLA Medical Center, Sylmar, California, United States
,
James H. Tabibian
3   Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, United States
4   David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Abstract

Background 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.

Methods 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.

Results 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.

Conclusions 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.



Publication History

Received: 19 February 2020

Accepted: 11 May 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Gaidos JK, Draganov PV. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 2009; 15: 4365-4371
    CrossrefPubMedGoogle Scholar
  • 2 Athreya S, Moss J, Urquhart G. et al. Colorectal stenting for colonic obstruction: The indications, complications, effectiveness and outcome: 5-year review. Europ J Radiology 2006; 60: 91-94
    CrossrefPubMedGoogle Scholar
  • 3 Ma L, Huang X, Lian J. et al. Transparent cap-assisted endoscopic sclerotherapy in esophageal varices: a randomized-controlled trial. Europ J Gastroenterol Hepatol 2018; 30: 626
    CrossrefPubMedGoogle Scholar
  • 4 Biecker E, Floer M, Heinecke A. et al. Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol 2015; 49: 413
    CrossrefPubMedGoogle Scholar
  • 5 Zhang S, Wang J, Wang J. et al. Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: A randomized, controlled trial. J Gastroenterol Hepatol 2013; 28: 1339-1342
    CrossrefPubMedGoogle Scholar
  • 6 Trindade AJ, Mella JM, Slattery E. et al. Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography. Endoscopy 2015; 47: 453-456
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Sumiyama K, Rajan E. Endoscopic caps. Tech Gastrointest Endosc 2006; 8: 28-32
    CrossrefPubMedGoogle Scholar
  • 8 Myung DS, Park CH, Koh HR. et al. Cap-assisted ERCP in patients with difficult cannulation due to periampullary diverticulum. Endoscopy 2014; 46: 352-355
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Desai M, Sanchez-Yague A, Choudhary A. et al. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 274-281.e3
    CrossrefPubMedGoogle Scholar
  • 10 Tang Z, Zhang DS, Thrift AP. et al. Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial. Gastrointest Endosc 2018; 87: 723-732.e3
    CrossrefPubMedGoogle Scholar
  • 11 McCarty TR, Garg R, Thompson CC. et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1474-E14782
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Wang G, Liu X, Wang S. et al. Endoscopic ultrasound-guided gastroenterostomy: a promising alternative to surgery. J Transl Int Med 2019; 7: 93-99
    Google Scholar