Colon Cancer 6
This is just showing the stent now in position. The guide-wire and delivery system is very carefully being removed, but you can see the annulated portion of the tumor in this region here with plenty of stent on each side. This device can actually be removed, or you can adjust this position after its placement. Keep in mind, be very careful when you remove the delivery system. It’s possible to snag on any of the stents and pull it out. This is just showing an endoscopic view of the lumen. This is an 18 mm diameter and the patient is now swallowing contrast material and you can see that pass through quite nicely off the distal end. So again, a successful placement.
A second video clip just showing the placement of Wilson-Cook Z stent. Again it comes in different sizes. It’s coded and it has flared ends on both sides. That’s hopefully to anchor the stent once it is positioned. The delivery system here is a bit different. More of the typical sheath retraction delivery system. But just watch. The tumor is located here and the upper margin is about there, but just watch as this stent is deployed there will be very minimal retraction. So fairly precise measurements can be made and hopefully you can maintain that precision when the stent is deployed. Here you can see the stent being slowly released as the sheath is being withdrawn, and you’ll see the delivery system and guide-wire have been carefully removed through the stent. This kind of device doesn’t quite have the radial force, as mentioned, of the EsophaCoil so you have to be very careful. It may not be fully opened for a minute or two. Always allow plenty of time for full deployment of the stent. In some situations you may actually want to go back down with the scope afterwards and carefully pass a TTS balloon to kind of aid in the full expansion of the stent. So here we are removing the guide-wire, you can look inside and if you think you need to, suggested by the radiographs, you may want to pass a TTS balloon and help the stent deploy a little bit further.
Okay, slides again. Those are two examples where things went pretty well. Does it always go that way? Of course not. This is called a “birds nest sign”. This is an EsophaCoil where the distal and proximal portions of the stent were beautifully released, and in the mid-portion unfortunately the whole thing just coiled up. Just kind of happened that way. Fortunately this can be taken care of. You can remove the EsophaCoil by grabbing the proximal end and just carefully removing the stent, and then a second was placed allowing for adequate lumen stenting.