Colorectal self-expanding metal stent insertion using a small-caliber tapered transparent hood and electrolyte-free gel.

Abstract

Colorectal self-expanding metal stent insertion is a useful procedure to treat acute colorectal obstruction caused by advanced colorectal cancer; however, guidewire perforation has been reported to occur as a result of inadequate endoscopic visibility [1] [2]. It is therefore important to maintain endoscopic visibility of the stricture to allow safe insertion of the colorectal stent. A method to maintain endoscopic visibility using an electrolyte-free gel (Viscoclear; Otsuka Pharmaceutical Factory) has recently been reported [3] [4]; however, it is difficult to maintain proper endoscopic visibility when the endoscopic hood has a large volume, as in the case of a conventional transparent hood. We previously reported a technique to obtain an appropriate field of view under saline immersion conditions using a calibrated, small-caliber tip, transparent hood (CAST hood; TOP, Tokyo, Japan) that has a tapered tip ([Fig. 1]) [5]. Herein, we report the use of a novel technique for colorectal stent insertion using this small-caliber tapered transparent hood and electrolyte-free gel ([Video 1]).