article = {SCR-2020-11-115}
title = {“Stent in Stent” Procedure for Treatment of Extreme Strictures of Colorectal Cancer – Case Series in a Single Center: How to Do it}
journal = {Surgical Case Reports}
year = {2020}
issn = {2613-5965}
doi = {http://dx.doi.org/10.31487/j.SCR.2020.11.15}
url = {https://www.sciencerepository.org/stent-in-stent-procedure-for-treatment-of-extreme-strictures_SCR-2020-11-115 
author = {Giungato  Simone,Giordano  G,Fazzolari  L,Putignano  C,Rahaza  L,De  Luca A,Dimito  C,Pepe  AS,De  Luca GM,}
keywords = {Stent, cancer, bridge-to-surgery, obstruction, endoscopy, surgery}
abstract ={Background: Since 1990’s the use of self-expanding metal stent has been known. Initially, this kind of
technique has been debated in literature. Actually, is a widely used technique for treatment of bowel
neoplastic obstruction. This procedure is important to restore bowel canalization but is feasible performed
by expert endoscopists and a dedicated anesthesiologist team. More difficult seems to be the treatment of
strictures longer than 9 cm of large bowel or synchronous very close stenosis of rectal-sigmoid junction and
rectum. This technical note demonstrated how SEMS positioning can be performed for treatment of long
and extreme large bowel obstruction.
Methods: In this case series we have treated all patients admitted in our department with diagnosis of
extreme bowel neoplastic obstruction, with “stent in stent” technique, in deep sedation.
Results: From January to August 2019 we admitted in our Surgical and Endoscopic Unit two patients, a 90-
year-old for bowel obstruction by synchronous colorectal cancer and a 80-year-old female for 15 cm large
bowel neoplastic obstruction. Patients were submitted to “Stent-in-Stent” technique. No complications and
perforation were observed with restore of bowel canalization after few hours from SEMS positioning. Both
patients had no signs of bowel obstruction at abdomen X-Ray control, after 48 hours. 80-year-old female
patient was submitted to left colectomy after 6 days without complications, while 90-year-old was discharge
after 3 days.
Conclusion: This study demonstrated how is possible to perform endoscopic SEMS positioning to treat
longer than 15 cm neoplastic large bowel obstruction and synchronous colorectal cancer with “Stent-inStent” technique. Our technical note describes, point by point, all passages of this procedure and suggests
as is possible to treat synchronous sigmoid-rectal neoplastic obstruction using two different kind of metal
stent.}