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Open Access
CC BY 4.0 · Endosc Int Open
DOI: 10.1055/a-2733-0780
Original article

Optimizing Self-Expandable Metallic Stent Placement for Malignant Ileocecal Obstruction: Role of Pre-Stenting Contrast Enema and Device Selection

Autoren

  • Akihiro Maruyama 

    1   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Hiroshi Nakayabu

    1   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Hirotaka Takeshima

    1   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Hiroki Kato 

    1   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Shintaro Tominaga

    1   Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)

  • Makoto Kobayashi 

    2   Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (Ringgold ID: RIN37036)
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Background: 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. 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; procedural efficiency was the secondary outcome. Clinical success was additionally 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), while median procedure times were similar (40.0 vs. 35.0 minutes, p = 0.934). In the ileocecal group, all cases 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 procedural advantages. Conclusions: SEMS placement in the ileocecal region is technically more challenging than in other right-sided segments. Procedural optimization—potentially aided by CLEAN, tapered hoods, and experienced operators—may help overcome anatomical difficulties while maintaining safety.



Publikationsverlauf

Eingereicht: 19. April 2025

Angenommen nach Revision: 24. Oktober 2025

Accepted Manuscript online:
27. Oktober 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Akihiro Maruyama, Hiroshi Nakayabu, Hirotaka Takeshima, Hiroki Kato, Shintaro Tominaga, Makoto Kobayashi. Optimizing Self-Expandable Metallic Stent Placement for Malignant Ileocecal Obstruction: Role of Pre-Stenting Contrast Enema and Device Selection. Endosc Int Open ; 0: a27330780.
DOI: 10.1055/a-2733-0780