Video Tip: Stent Placement: Checklist and Technique | November 2021-Stent Placement: Checklist and Technique

Video Transcription

So let's talk a little bit about the technique and post-procedure management. We are talking about  a therapeutic procedure and I think that you all agree that all therapeutic endoscope procedures should be performed under CO2 insufflation and with the help of anesthesiologists.  And here is my checklist. Consenting, surgical consultation is very important. I think that  all the indications of colorectal stenting should be discussed in a multidisciplinary cancer board.  CO2 insufflation, general anesthesia or at least deep sedation provided by anesthesiologists  should be available. Fluoroscopy, a large channel, gasoscope at least 3.2 because the stents they  come in a delivery system that are at least 10 French or 8.5 French. You need a hydrophilic  guide wire, ERCP catheter and we make available in the room all the lengths of the stents 6, 9,  12 centimeter uncovered colorectal enteral stents and contrast is always used. So here are short  video on the technique. You may appreciate here the distal border of the cancer and I'm using a  therapeutic gastroscope. I negotiate the stricture with a hydrophilic guide wire and now I'm advancing  the ERCP catheter over the guide wire. Pretty much the same when you do  a stenting in the biliary tree. Now under fluoroscopic view I inject some contrast and you appreciate here the stricture and the long segment of dilated bowel  and under fluoroscopic and endoscopic control we are introducing the stent. You see here the  fluoroscopic image and very easy to pass introduce the stent over the guide wire and now you are  deploying the stent under fluoroscopic but mainly under endoscopic guidance. You see here the end  of the stent so I want that the stent to be at least two centimeters distal to the distal border  of the tumor. So at least two centimeters of stent below the distal border of the tumor and so here  is the point of no return and you see the fully deployment of the stent, the stricture and now injecting some contrast and you see the cancer is bypassed with the stent.

Video Summary

In this video, the speaker discusses the technique and post-procedure management for a therapeutic endoscope procedure. They emphasize the importance of performing the procedure under CO2 insufflation and with the assistance of anesthesiologists. The speaker provides a checklist, including obtaining consent and discussing indications for colorectal stenting in a multidisciplinary cancer board. They also mention the equipment required, like a therapeutic gastroscope, hydrophilic guide wire, and ERCP catheter. The video then demonstrates the procedure, showing the negotiation of the stricture with the guide wire and the introduction and deployment of the stent under fluoroscopic and endoscopic guidance. The video concludes by showing the successful bypass of the cancer with the stent.

Keywords

therapeutic endoscope procedure

CO2 insufflation

colorectal stenting

multidisciplinary cancer board

fluoroscopic and endoscopic guidance