[Endoscopic stenting for patients with malignant colorectal obstruction in our hospital].

In January 2012, the Wall Flex Colonic Stent (Boston Scientific) for treating patients with malignant colorectal obstruction was included in the National Health Insurance (NHI) price list in Japan, and since July 2012, our hospital has placed this stent in 22 patients(as bridge-to-surgery [BTS] in 14 patients and as palliative treatment in 8 patients). The subjects included 13 men and 9 women, aged 27-94 years. The placement sites were the ileocecal lesion in 1 patient, the ascending colon in 1 patient, the transverse colon in 3 patients, the descending colon in 6 patients, the sigmoid colon in 4 patients, and the rectum in 7 patients. Stent placement was successful in all 22 patients (100%). The primary endpoint was improvement in scores on the ColoRectal Obstruction Scoring System (CROSS). The mean CROSS score before stenting was 1.18. The mean CROSS score after stenting was 3.71. Only 1 patient showed no change in the CROSS score(before versus after stenting). The rate of clinical efficacy was 95.4%. One patient experienced restenosis, an accidental event, requiring re-stenting after 3 days. There was 1 case of stent migration, which occurred 32 days after stenting. Colonic stent placement, as BTS and palliative treatment, is effective in improving the quality of life (QOL) of patients.

[Learning experiences of colorectal ESD in a community general hospital].

Learning how to perform colorectal endoscopic submucosal dissection (ESD) is considered difficult because of different factors including the thin colorectal wall, poor fixation, numerous folds and flexures, and changing conditions over time. A surgeon with experience in performing 25 gastric ESDs began to perform colorectal ESD after fully communicating and consulting with the Department of Surgery and obtaining adequate informed consent. Herein, we examined the results of colorectal ESD performed for 57 lesions between July 2012 and September 2013. Moreover, we selected the first 10 cases (early-phase) and the last 10 cases (late-phase) from 33 colorectal ESD cases to compare the results between the early-phase and late-phase groups. For sites where it was difficult to perform colorectal ESD, it was possible to perform ESD by changing the detachment device, tip attachment, body position, and endoscope. As the surgeon gained experience in performing gastric ESD, the colorectal procedure in the late phase group could be performed with greater speed, and a rising learning curve was observed. An incidental event of delayed perforation occurred in 1 case, for which laparoscopic partial colectomy was performed immediately after the definitive diagnosis had been made.