P-299 - Contrast medium marking for gastrointestinal stenting

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Palliative Care
Gastrointestinal Cancers
Presenter J. Ninomiya
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors J. Ninomiya, M. Kobayashi
  • Yokkaichi Municipal Hospital, Yokkaichi/JP

Abstract

Introduction

Marking is important for the placement of gastrointestinal stents. Especially stenting in the lower esophagus and rectum requires accuracy because migration of the stent in the esophagus causes gastroesophageal reflux and migration in the rectum influences the method of surgical resection. Stenting using markings outside of the body, for example putting injection needles on the skin, often becomes inaccurate due to body movements and breathing. Regarding gastrointestinal marking with endoscopic clips placed outside of the stent, there is a risk for later perforation of the gastrointestinal tract. If a normal-sized endoscope cannot pass through the stricture, endoscopic marking at the distal side of the gastrointestinal tract is difficult. The author suggests a new marking method for accurate stenting.

The water-soluble contrast medium ‘iopamidol’ has been used for endoscopic injection sclerotherapy and is considered to be safe even if injected into the submucosa of the gastrointestinal tract. The author used iopamidol injected into the submucosa as a marker for stenting through a fluoroscope.

Methods

Iopamidol (62.14%, 20 ml of 1A) was used as a water-soluble contrast medium. First, a small bulge with saline was made by the thin endoscope and needle under the mucosa to prevent injection of iopamidol outside of the gastrointestinal tract. Then, 2-3ml of iopamidol was injected into the bulged area with confirmation by fluoroscopy. Iopamidol was injected to mark the proximal and distal side of the stenosis.

Fifty patients with unresectable malignant constriction of the gastrointestinal tract underwent stent placement using iopamidol. Eighteen patients had cancer of the esophagus, 2 had stomach cancer, 4 had duodenal stenosis due to stomach cancer, 18 had colon cancer, and 8 had rectal cancer.

Results

Marking and stenting were possible in all cases with the contrast medium marking method. Iopamidol injected in the proximal and distal side of the stricture showed the endoscopist the length of the stricture through the fluoroscope and helped for accurate stent placement. Accidental injection of iopamidol did not occur. A thin endoscope made it possible to mark the distal side of the stenosis. In the future, slightly more contrast medium should be injected because it fades over time and becomes difficult to recognize.

Conclusion

Marking by injection of the water-soluble contrast medium ‘iopamidol’ into the submucosa was useful for gastrointestinal stent placement.

Figure: P-299