LOW-PRESSURE SELF-EXPANDABLE METAL STENT INSERTION FOR OBSTRUCTIVE COLON CANCER USING GEL IMMERSION(WITH A VIDEO)

Abstract

Colonic self-expandable metal stents (SEMS) are used as a bridge to surgery (BTS) or palliative treatment for obstructive colorectal cancer. Although technical success rates are high, adverse events, such as bleeding, perforation, and migration, can occur. These events are often caused by poor visualization from residual stool and difficulty identifying the tumorʼs luminal opening during insufflation, which can lead to excessive air insufflation and inappropriate guidewire manipulation. To address these challenges, gel immersion endoscopy (GIE)—a technique in which the lumen is filled with gel to maintain a clear view during endoscopic procedures—has recently been introduced. SEMS insertion under water or gel immersion may prevent over-insufflation, improve visualization, and enhance maneuverability, thereby reducing patient stress and facilitating safer SEMS placement.