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CC BY 4.0 · Endosc Int Open 2025; 13: a26950679
DOI: 10.1055/a-2695-0679
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Novel segmentally deployable self-expandable metallic stent in malignant colorectal obstruction

Takashi Murakami 
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
,
Tomonori Yamauchi
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
,
Eiji Kamba
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
,
Sho Takahashi
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
,
Yusuke Takasaki
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
,
Akihito Nagahara
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
2   Department of Pathophysiological Research and Therapeutics for Gastrointestinal Disease, Juntendo University Faculty of Medicine, Tokyo, Japan
,
Hiroyuki Isayama 
1   Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine, Tokyo, Japan
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Introduction

We report two successful cases of colonic stenting using a newly developed self-expandable metallic stent (SEMS) with suture-based segmental-release deployment system (SR), the Bactrian SR colonic stent (SB-Kawasumi Laboratories Inc., Kanagawa, Japan). This novel uncovered SEMS is made from nickel-titanium features hook-and-cross braided design that provides low axial and sufficient radial forces [1]. The delivery system has a three-layer design comprising an outer sheath, suture-based deployment system, and inner catheter. This system has three independently deployable segments — oral, central, and anal — whose deployment order can be selected ([Fig. 1], [Video 1]). Compared with the conventional one-step outer sheath pulling-back deployment, the deployment order from oral/anal deployment at the center may be more effective for precise placement [2].

Zoom
Fig. 1 Demonstration of deployment of the segmental-release self-expandable metallic stent (SEMS), Bactrian SR colonic stent (SB-Kawasumi Laboratories Inc., Kanagawa, Japan), in vitro. a SEMS before deployment. The SEMS was deployed in the following order: b anal, c oral, and d central segments. These segments can be released at any order of magnitude.
Deployment of segmentally deployable self-expandable metallic stents in two cases of malignant colorectal obstruction.Video 1


 

Case report

Case 1 was an 82-year-old man undergoing chemotherapy for transverse colon cancer who presented with vomiting and abdominal distension. Colonoscopy revealed a near-circumferential obstructive tumour with a 9-cm stricture (ColoRectal Obstruction Scoring System (CROSS) [3] score of 1). A 22 mm × 12 cm SEMS was deployed in three steps — oral, anal, and central — with accurate adjustments under fluoroscopic guidance.

Case 2 was an 88-year-old man with appetite loss and vomiting who was diagnosed with sigmoid colon cancer and liver metastases (CROSS [3] score of 1). Colonoscopy confirmed a type 2 tumor causing a 4-cm stricture. Although endoscopic access was unstable owing to the location of the lesion, a 22 mm × 12 cm SEMS with suture-based segmental release was successfully deployed ([Fig. 2]).

Zoom
Fig. 2 Stepwise deployment of a segmental-release SEMS in Case 2. a Fluoroscopic image showing a 4-cm stricture at the sigmoid colon flexure. b Initial deployment of the oral and anal segments of the stent using the segmental-release system. c Final deployment of the central segment after adjusting the stent position to ensure the stricture is centred within the stent.

In both cases, segmental release was effective and placing the SEMS at the expected portion precisely was possible. Patients resumed oral intake on postoperative Day 2 and showed no adverse events for 2 months after stent placement.


 

Conclusions

These cases highlight the utility of segmentally deployable SEMS in managing malignant colorectal obstruction, especially in unstable or angulated segments, where precise positioning is essential to avoid complications, such as perforation.


 

 

Contributorsʼ Statement

Takashi Murakami: Investigation, Methodology, Resources, Writing - original draft, Writing - review & editing. Tomonori Yamauchi: Investigation, Resources. Eiji Kamba: Investigation, Resources. Sho Takahashi: Investigation, Resources. Yusuke Takasaki: Investigation, Resources. Akihito Nagahara: Supervision, Writing - review & editing. Hiroyuki Isayama: Project administration, Supervision, Writing - review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

  • References

  • 1 Isayama H, Nakai Y, Toyokawa Y. et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc 2009; 70: 37-44
    Search in Google Scholar
  • 2 van Hooft JE, Veld JV, Arnold D. et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020; 52: 389-407
    Search in Google Scholar
  • 3 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
    Search in Google Scholar

Correspondence

Dr. Takashi Murakami
Department of Gastroenterology, Juntendo University, Postgraduate School of Medicine
Tokyo
Japan   

Publication History

Received: 24 May 2025

Accepted after revision: 19 August 2025

Article published online:
15 September 2025

© 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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Bibliographical Record
Takashi Murakami, Tomonori Yamauchi, Eiji Kamba, Sho Takahashi, Yusuke Takasaki, Akihito Nagahara, Hiroyuki Isayama. Novel segmentally deployable self-expandable metallic stent in malignant colorectal obstruction. Endosc Int Open 2025; 13: a26950679.
DOI: 10.1055/a-2695-0679

  • References

  • 1 Isayama H, Nakai Y, Toyokawa Y. et al. Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc 2009; 70: 37-44
    Search in Google Scholar
  • 2 van Hooft JE, Veld JV, Arnold D. et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020; 52: 389-407
    Search in Google Scholar
  • 3 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
    Search in Google Scholar

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Zoom
Fig. 1 Demonstration of deployment of the segmental-release self-expandable metallic stent (SEMS), Bactrian SR colonic stent (SB-Kawasumi Laboratories Inc., Kanagawa, Japan), in vitro. a SEMS before deployment. The SEMS was deployed in the following order: b anal, c oral, and d central segments. These segments can be released at any order of magnitude.
Zoom
Fig. 2 Stepwise deployment of a segmental-release SEMS in Case 2. a Fluoroscopic image showing a 4-cm stricture at the sigmoid colon flexure. b Initial deployment of the oral and anal segments of the stent using the segmental-release system. c Final deployment of the central segment after adjusting the stent position to ensure the stricture is centred within the stent.