Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction

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

• 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
• 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
• 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
• 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
• 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
• 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
• 7 Sumiyama K, Rajan E. Endoscopic caps. Tech Gastrointest Endosc 2006; 8: 28-32
• 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
• 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
• 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
• 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
• 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