Optimizing self-expandable metallic stent placement for malignant ileocecal obstruction: Role of pre-stenting contrast enema and device selection

Abstract

Background and study aims

Self-expandable metallic stent (SEMS) placement is an established intervention for malignant colorectal obstruction, but the ileocecal region presents unique anatomical challenges. This study aimed to evaluate the technical success of SEMS placement for malignant ileocecal obstruction and to examine the impact of pre-stenting preparation and device selection.

Patients and methods

We retrospectively analyzed 72 patients with right-sided malignant colonic obstruction (13 ileocecal, 59 other segments) treated between January 2011 and March 2025. The primary outcome was the technical success rate; procedure efficiency was the secondary outcome. Clinical success was also evaluated in the ileocecal group according to treatment intent. All ileocecal cases underwent contrast liquid enema-assisted navigation (CLEAN) to assist device selection. Subgroup analyses examined scope diameter, hood shape, operator experience, and catheter tip mobility.

Results

Technical success was significantly lower in the ileocecal group (76.9% vs. 98.3%, P = 0.017), whereas median procedure times were similar (40.0 vs. 35.0 minutes, P = 0.934). In the ileocecal group, all patients with technical success also achieved clinical success. No major complications occurred. Tapered hoods significantly shortened procedure time (26.0 vs. 50.0 minutes, P = 0.018), and expert operators completed procedures faster than trainees (30.5 vs. 58.0 minutes, P = 0.042). Although movable-tip catheters and smaller-diameter scopes showed no statistical differences, selected cases demonstrated procedure advantages.

Conclusions

SEMS placement in the ileocecal region is technically more challenging than in other right-sided segments. Procedure optimization – potentially aided by CLEAN, tapered hoods, and experienced operators—may help overcome anatomical difficulties while maintaining safety.

Keywords

Endoscopy Lower GI Tract - Stenting - Colorectal cancer - Quality and logistical aspects - Preparation

Publication History

Received: 19 April 2025

Accepted after revision: 24 October 2025

Accepted Manuscript online:
27 October 2025

Article published online:
10 November 2025

• References

• 1 Saida Y. Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature. J Anus Rectum Colon 2019; 3: 99-105
• 2 Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 1991; 3: 1507-1512
• 3 Kawa B, Thomson B, Rabone A. et al. Percutaneous antegrade colonic stent insertion using a proximal trans-peritoneal colopexy technique. Cardiovasc Intervent Radiol 2018; 41: 1618-1623
• 4 Juakiem WY, Singh K, Ofosu A. et al. Tertiary care center trends in colonic stent placement over the past decade. Cancers (Basel) 2024; 16: 3309
• 5 Oh HH, Cho SB, Hong JY. et al. Clinical outcomes of palliative self-expandable metal stent placement in right- and left-sided malignant colon obstruction: A Honam Association for the Study of Intestinal Disease (HASID) multicenter study. Medicine (Baltimore) 2022; 101: e30156
• 6 Takeyama H, Danno K, Kogita Y. et al. Laparoscopic colectomy after self-expanding metallic stent placement through the ileocecal valve for right-sided malignant colonic obstruction: A case report. Asian J Endosc Surg 2018; 11: 262-265
• 7 Makhejani KR, Haq MMU, Iqbal J. et al. Self-expanding metallic stent placement in malignant terminal ileal stricture. J Coll Physicians Surg Pak 2019; 29: S89-S91
• 8 Wu Y, Li X, Xiong F. et al. Malignant obstruction in the ileocecal region treated by self-expandable stent placement under the fluoroscopic guidance: A case report. World J Clin Cases 2022; 10: 11529-11535
• 9 Ishii T, Minaga K, Ogawa S. et al. Effectiveness and safety of metallic stent for ileocecal obstructive colon cancer: a report of 4 cases. Endosc Int Open 2017; 5: E834-E838
• 10 Kato H, Kobayashi M, Tagawa R. The usefulness of barium enema using a water-soluble contrast medium as an emergency examination. Rev Esp Enferm Dig 2025.
• 11 Murakami T, Isayama H, Ikeda S. et al. A new self-expandable metallic stent with low axial force and a high axial force zero-border shows a very low perforation rate in malignant colorectal obstruction: A Japanese multicenter prospective study. J Clin Med 2024; 13: 5102
• 12 Sasaki T, Yoshida S, Isayama H. et al. Short-term outcomes of colorectal stenting using a low axial force self-expandable metal stent for malignant colorectal obstruction: A Japanese multicenter prospective study. J Clin Med 2021; 10: 4936
• 13 Keymling M. Colorectal stenting. Endoscopy 2003; 35: 234-238
• 14 Fujisawa G, Ishibashi R, Yoshida S. et al. ChatGPT said: Safety and effectiveness of colonic stenting for ileocecal valve obstruction and usefulness of two-step strategy: Single-center retrospective study. J Clin Med 2025; 14: 826
• 15 Takahama T, Ban T, Kubota Y. et al. Self-expandable metallic stent deployment across the ileocecal valve in a patient with an acute colonic obstruction. Endoscopy 2023; 55: E96-E97
• 16 Nomura T, Sugimoto S, Temma T. et al. Colorectal self-expanding metal stent insertion using a small-caliber tapered transparent hood and electrolyte-free gel. Endoscopy 2023; 55: E633-E634
• 17 Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol 2011; 2011: 917848
• 18 Lee JH, Yoon JY, Park SJ. et al. The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction. Gut Liver 2012; 6: 328-333
• 19 Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010; 71: 560-572
• 20 Maruyama A, Kobayashi M, Takeshima H. et al. Ileocecal stent placement for malignant obstruction using a side-viewing endoscope and a balloon-equipped overtube. Endoscopy 2025; 57: E41-E43
• 21 Matsuda A, Miyashita M, Matsumoto S. et al. Comparison between metallic stent and transanal decompression tube for malignant large bowel obstruction. J Surg Res 2016; 205: 474-481