LAUSR

Self-expandable metal stents (SEMSs) are widely used around the world for malignant colonic and extracolonic obstruction; however, malignant obstruction in the proximal colon, and complicated and long-segment stenoses are difficult cases [1, 2]. Several articles have reported SEMS placement in the proximal colon using a balloon enteroscopy overtube and the over-the-[guide]wire technique under fluoroscopic guidance, and without endoscopic guidance [3, 4]. The outer sheaths of SEMSs have become thinner, reducing from 10Fr to 9 Fr, and the short-type single-balloon enteroscope with a 3.2-mm working channel is now available for SEMS placement using a combination of the through-the-scope and over-the-wire techniques. An 88-year-old man presented with abdominal fullness and postprandial vomiting. Contrast-enhanced computed tomography (CECT) showed wall thickening in the ascending colon and dilatation from the lesion to the small bowel (▶Fig. 1). The patient was diagnosed with cancer of the ascending colon, with tumor thrombosis in the superior mesenteric vein. SEMS placement with a standard colonoscope was attempted, but was unsuccessful. Transnasal ileus tube placement was performed for decompression of the smalland large-bowel (▶Fig. 2). Repeat CECT showed decompression of the smalland large-bowel, along with an extremely complicated ascending colonic route (▶Fig. 3). The patient was unfit for surgery because of his age, frailty, and progressive disease status. Therefore, a SEMS was placed for palliation using short-type single-balloon enteroscopy (SBE; SIF-H290S; Olympus Corp., Japan) (▶Video 1). The short-type single-balloon enteroscope reached the lesion with the use of the overtube. Although it was difficult to obtain a stable endoscopic position with a view from the front because of the extremely com▶ Fig. 1 Contrast-enhanced computed tomography images showing the dilated small bowel and ascending colon, along with wall thickening of the ascending colon (red arrowheads) and tumor thrombosis in the superior mesenteric vein on: a axial view; b coronal view. ▶ Fig. 2 Fluoroscopic view with contrast media showing the stenosis of the ascending colon (red arrowheads) and complicated ascending colon route on the anal side of the lesion (yellow arrowheads).