A case report of colonic stent placement without X-ray control in the COVID-19 era: a practical method or a mistake?

During the recent 2-year quarantine, the coronavirus disease 2019 (COVID-19) pandemic changed the course of medical treatment and posed some new challenges to the care of particularly vulnerable oncology patients. Despite the re-purposing of The Second University Clinic (Sechenov University), we still admitted many patients with colonic obstruction. The endoscopic unit was situated in a separate facility, but due to the intensive use of all of our X-ray equipment for COVID-19 patients, the question arose about the possibility of placing a stent without fluoroscopic control. Here, we present the first case report of colonic stent placement without X-ray guidance.

An 81-year-old woman was admitted in January 2021 with clinical signs of colonic obstruction. An emergency computed tomography (CT) abdominal scan revealed an irregular focal thickening of the wall of the rectosigmoid. At the medical case conference, a minimally invasive intervention was recommended to decompress the intestine and prepare the patient for radical surgery. A colonoscopy of the rectosigmoid area showed circumferential tumor infiltration with narrowing of the lumen to approximately 3 mm. Bowel decompression was performed by placing a self-expandable metallic stent (SEMS) via colonoscopy without fluoroscopic monitoring. After performing the stenting procedure, the patient's clinical symptoms were relieved, and she reported passing of stool and gases, pain reduction, and reduction of abdominal bloating.

In 6 months we performed 13 colonic stentings with effective decompression of the intestines without any complications. From our point of view, our forced clinical experience showed us that in desperate situations with severely impacted patients, an experienced endoscopic team can perform colonic stenting without direct X-ray navigation (provided there is the appropriate selection of stent design and size according to findings on a preliminary CT scan), if due to unforeseen circumstances an X-ray is unavailable.