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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
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39079524
10.1055/a-2324-2108
E-Videos-2024-01-4711-EV
E-Videos
A radiation-free novel approach for intestinal stent placement: the “scope-in-scope” technique
Hu Jiaqing Dr.
Zheng Jinhui Dr.
Yang Changshun Dr.
Gao Xiang Dr.
Guo Xianbin Dr.
Zheng Xiaoling MD
1 117861 Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
2 117861 Fujian Medical University Provincial Clinical Medical College, Fuzhou, China
3 117861 Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
4 117861 Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
5 117861 Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
6 117861 Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
7 117861 Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
Correspondence Xiaoling Zheng, MD Department of Gastrointestinal Endoscopy, Fujian Provincial HospitalFuzhou City, Fujian Province, CN 350001Chinafjzhengxl@163.com
30 7 2024
8 2024
1 7 2024
56 8 632633
The Author(s). This article was originally published by Thieme in Endoscopy 2024; 56: E313–E314 as an open access article under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Natural Science Foundation of Fujian Province 10.13039/501100003392 2021J01388 Fujian Medical University 10.13039/501100013795 2022QH1299
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pmc An elderly woman with persistent abdominal pain and bloating was diagnosed with obstructive sigmoid colon cancer on computed tomography (CT) ( Fig. 1 ). Because of a low oxygen saturation value caused by secondary aspiration pneumonia she was admitted to the intensive care unit; therefore transfer to a fluoroscopy-equipped operating room was inappropriate.

Fig. 1 Abdominal computed tomography in an elderly woman, showing a sigmoid colon mass with distension of the distal bowel (arrow).

After multidisciplinary discussions, colonic stent placement was decided upon, using the “scope-in-scope” technique that combines digital single-operator cholangioscopy with colonoscopy. The colonoscope was used to approach the sigmoid colon, where an infiltrative mass was causing luminal narrowing ( Fig. 2 ). Then the cholangioscope (9-Fr, EyeMax; Micro-Tech, Nanjing, China) was inserted directly through the colonoscope biopsy channel.

Fig. 2 Colonoscopy showed an infiltrative mass in the sigmoid colon, accompanied by luminal narrowing.

The forward direction of the cholangioscope can be flexibly adjusted using the operating unit ( Video 1 ) and narrow lumens can be navigated under direct visualization. Thus clear observation of the internal structure of the colonic tumor was possible ( Fig. 3 ). The cholangioscope was advanced accompanied by irrigation with saline. Passage beyond the obstructed segment was confirmed when dilated intestinal lumen was seen ( Fig. 4 ).

“Scope-in-scope” technique, combining cholangioscopy and colonoscopy: swift placement of an intestinal stent without fluoroscopic guidance.

Video 1

Fig. 3 Cholangioscopy image: ulceration and necrotic areas are observed within the tumor cavity.

Fig. 4 The cholangioscope showed dilated intestinal lumen, indicating passage beyond the obstructed segment.

A 0.035-inch guidewire was inserted through the forceps channel of the cholangioscope and positioned on the oral side of the tumor. The guidewire was maintained in this position as the cholangioscope was withdrawn, measuring the length of the tumor for stent selection. Guided by the wire and direct visualization, an uncoated metal intestinal stent (25 mm diameter, 9 cm length; Boston Scientific) was gradually deployed. It was possible to introduce the cholangioscope into the lumen of the incompletely expanded stent, to ensure that the stent extended beyond both ends of the narrowed segment ( Fig. 5 ).

Fig. 5 Cholangioscopy image: the cholangioscope can be introduced into the incompletely expanded stent lumen.

Postoperatively, the patient experienced significant relief from abdominal pain and bloating, bowel movements were successfully resumed, and no complications such as bleeding or perforation were encountered.

Traditional procedures for endoscopic stent placement 1 may lead to radiation exposure for both doctors and patients. This new method is particularly beneficial for certain groups, such as pregnant women, children, and patients with fragile constitutions. The “scope-in-scope” method described above, akin to its application in the appendiceal cavity 2 , uniquely allows direct observation and treatment for colonic obstructions and may reduce the risk of perforation and bleeding.

It presents a safer and more efficient alternative for stent placement in patients for whom fluoroscopy is undesirable or at institutions lacking fluoroscopic equipment.

Endoscopy_UCTN_Code_TTT_1AQ_2AF

Citation Format Endoscopy 2024; 56: E313–E314. doi: 10.1055/a-2291-9315

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Conflict of Interest The authors declare that they have no conflict of interest.
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References

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2 Kong LJ Liu D Zhang JY Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy Endoscopy 2022 54 396 400 10.1055/a-1490-0434 33893629
