Background: Self-expandable metal stent (SEMS) placement with an emergency colonoscope has been gradually applied to treat colorectal carcinoma with intestinal obstruction (CCIO). We proposed a new technique based on current SEMS placement with the combined application of ultrathin endoscope and guidewire replacement to solve previous technical difficulties. This study evaluated its feasibility, efficacy, and safety for SEMS placement in CCIO. Methods: We retrospectively analyzed data of 31 CCIO patients, who received the novel SEMS placement technique at Wuhan No.1 Hospital between June 2019 and October 2022. Technical and clinical success rates, adverse events, prognosis, and follow-up were evaluated. Inter-group differences between bridge to surgery (BTS) and palliative treatment (PT) groups and clinical feasibility of this technique were analyzed. Results: Overall technical and clinical success rates were 100% (31/31) and 96.8% (30/31), respectively, without adverse events. There was no significant difference in procedure time and technical/clinical success rates among three attending physicians(p>0.05). Fourteen BTS patients (14/31, 45.2%) underwent SEMS with a post-placement confined operation, which had a 100% success rate (14/14) and no ostomy. Median follow-up time was 67.5 days, and four patients (4/14, 28.6%) had postoperative adverse events of inflammatory anastomotic changes. Seventeen PT patients had a median follow-up time of 30 days, without adverse events. Two patients (2/17, 11.8%) underwent follow-up colonoscopywith no post-placement stent migration/obstruction. Conclusions: The combined application of ultrathin endoscope with guidewire replacement for SEMS placement to treat CCIO could avoid X-ray-induced medical radiation damage and reduce cross-infection risk, making it clinically safe, effective, and promotion suitable.

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Background Sellick maneuver is used for endotracheal intubation to prevent the occurrence of gastroesophageal reflux. Our study was to observe the effect of the Sellick maneuver on safety, esophageal closure status, gastric mucosal fold extension status, and positive detection rate of lesions in patients with esophageal hiatal hernia under painless gastroscopy. Methods Forty patients with esophageal hiatal hernia who underwent painless gastroscopy were screened for the Sellick maneuver, in which the operator applied pressure to the cervical cricoid cartilage during the examination. Compared with no-Sellick maneuver, we observed and recorded the status of esophageal closure at the pressing area, examination time, gastric mucosal fold extension score, positive rate of lesion detection, reflux of gastric juice or gastric contents, etc. Results After using the Sellick maneuver, the state of esophageal closure during gastroscopy was significantly better than the no-Sellick maneuver (P < 0.05), and the extension scores of the greater curvature folds of the gastric body, the lateral folds of the lesser curvature of the gastric body, and the mucosal folds of the fundus were significantly higher than that of the no-Sellick maneuver (P < 0.05). The number of gastric polyps examined with the Sellick maneuver was significantly more than no-Sellick maneuver(P < 0.01), and the number of gastric lesions examined (gastric ulcers, mucosal hyperplasia, etc.) was also significantly higher with the Sellick maneuver than no-Sellick maneuver (P < 0.01). The examination time was shorter with the Sellick maneuver than no-Sellick maneuver (p < 0.01). Reflux of gastric juice or gastric contents was superior to the no-Sellick maneuver (p < 0.01). The Sellick maneuver did not increase the degree of choking, as well as SPO2 variability and heart rate variability. Conclusions The Sellick maneuver effectively improved the extension of gastric mucosal folds during gastroscopy in patients with esophageal hiatal hernia, increased the positive detection rate of gastric lesions, and shortened the endoscopy time, while not increasing the incidence of cardia lacerations and didn’t affect the patient's voluntary breathing. Trial registration: The clinical trial was registered on (14/9/2022, ChiCTR2200063683)