Introduction

There is minimal data to support a recommendation to perform colonic stenting (SEMs) in the right colon, but particularly in malignancy in the region of the ileocaecal valve, where only small bowel dilatation results from obstruction. This scenario poses technical challenges in endoscopic access in unprepared proximal colon, and relating to the anatomy of the ileocaecal valve. One recent case series included 13 patients with reported success rate and equivalent outcomes to left-sided stents with median survival of 4 months, although a two-step procedure was described¹.

Aims & Methods

In our centre we attempt self-expanding metal stent insertion (SEMs) in cases of malignant ileocaecal obstruction, which constitutes ~9% of our overall SEMs caseload. We report our outcomes and, as an important metric for palliative patients, stoma-free survival in the context of colorectal cancer management. We perform stenting using colonoscopy to access the stricture and fluoroscopy for wire and stent deployment, with both over the wire and through the scope techniques.

Results

25 patients, median age 77 years, underwent intention to stent for colorectal malignancy at the ileocaecal junction, where stent deployment into the ileum would be necessary to overcome the obstruction. Clinical success with life-time avoidance of surgery or stoma was 68% without any adverse events from attempting SEMs. Median survival was 206 days, compared to 167 days in those where stenting was unsuccessful. This was not significantly different to median stoma-free survival of 272 days for all SEMs patients in our database. One patient, after technically successful stent deployment, re-obstructed within 7 days and underwent surgery. There were no other early or late complications in either group. Reasons for technical failure in 6 cases was inability to pass a wire into the ileum, bowel preparation in 1 case, and failure to adequately resolve obstruction in the aforementioned patient.

Conclusion

Stenting malignant colonic obstruction of the ileocaecal region is more technically challenging but does not appear to disadvantage patients after an unsuccessful procedure. Stoma or surgery is avoided in 68% cases in intention to treat analysis of 25 patients and median survival of 206 days is equivalent to other colonic stent locations.

References

1. Fujisawa et al. J. Clin. Med. 2025, 14(3), 826