Post written by Kanae Tao, MD, from the Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.

Our video case depicts the use of the newly developed proximal release-type colonic self-expandable metallic stent (SEMS) for malignant lower rectal obstruction close to the anal verge. A 64-year-old man presented with nausea and vomiting secondary to a malignant lower rectal obstruction located 2 cm from the anal verge. To palliate this obstruction, we used the newly developed SEMS. The SEMS was successfully deployed to the appropriate position, and no adverse events—including pain—occurred.

Colonic stenting for malignant lower rectal obstructions close to the anal verge is challenging due to the likelihood of severe pain due to their close proximity to the dentate line. It is technically difficult to precisely deploy a conventional distal release-type SEMS for tumors close to the anal verge. This new type of SEMS can be released from the anal (proximal) side. This feature addresses these problems and provides additional support for the efficacy of SEMS.

A major advantage of colonic stenting is that it is less invasive than emergency surgery. Surgery for tumors close to the anal verge can cause an artificial anus to develop. Use of a SEMS can help avoid this. The newly developed SEMS can be placed at the distal tumor edge to facilitate accurate positioning of the stent close to the anal verge. This newly developed proximal release-type colonic SEMS allows patients to avoid having a stoma placed, and may therefore, enhance quality of life.

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