A New Method of Endoscopic Stent Insertion for Gastrointestinal Luminal Stenosis Without Fluoroscopic Assistance

Abstract

Background & Aim: Endoscopic insertion of self-expanding metal stents (SEMS) is usually performed under fluoroscopic monitoring. Endoscopists sometimes encounter difficulties in using or accessing fluoroscopy facilities. This study was aimed at describing a new method of SEMS insertion using only endoscopic control, including the measurement of the stricture length by balloon retrieval maneuver, and also we compared the results of new method with traditional fluoroscopic monitoring method. Method: A total 37 patients, who had endoscopic SEMS positioned due to malignant obstruction, were retrospectively evaluated; 25 insertions were done with the fluoroscopic monitoring and 12 were inserted with a new endoscopic method without fluoroscopic monitoring. A new method had also advantages as prevention of twisting of the guide-wire. The first step in the insertion of SEMS without fluoroscopic monitoring begun with traversing the malignant stricture using a guide-wire induced balloon catheter. The balloon catheter was inserted as far as possible past the stenosis; air inflated balloon catheter was then slowly retrieved; the length of stenosis was measured with marking; and adequate length of SEMS was inserted in that order. Results: Successful insertion was achieved and obstruction was abolished in all patients of both group (100%) and there was no treatment-related mortality. But, 3 patients (1 of fluoroscopic monitoring group and 2 of new method group) experienced stent migration and 5 patients experienced tumor overgrowth (4 of fluoroscopic monitoring group and 1 of new method group). There were no statistical differences in successful rate, the median duration of hospitalization and complication rate between two groups. Conclusion: This method of endoscopic stent insertion without fluoroscopic monitoring could be useful and safe alternative to the current method using the fluoroscopic monitoring.