Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra-thin Scope and Single-balloon Overtube

Self-expanding metallic stents (SEMSs) are an established palliative option for malignant colonic obstruction, including in cases with proximal lesions. However, SEMS placement across the ileocecal valve (ICV) can be technically challenging because of the anatomical curvature and luminal stenosis. Herein, we report a successful case of colonic stenting for a malignant ileocecal obstruction using an ultra-thin scope and a single-balloon overtube. A 72-year-old man with alcoholic cirrhosis and multiple liver metastases presented with malignant ileocecal obstruction. Given his inoperability, palliative SEMS placement was attempted. Colonoscopy showed a circumferential tumor in the ileocecum, with no passage of contrast medium into the ileum. Guidewire insertion across the ICV failed because of the inability to visualize the direction of the ileal lumen. To overcome this, we used a rescue technique with an ultra-thin scope and a single-balloon overtube. After placing the overtube in the ascending colon, the ultra-thin scope was advanced through it to explore the stenotic lumen directly. This allowed safe insertion of the guidewire into the proximal lumen of the stenosis. The ultra-thin scope was withdrawn, and a standard scope was inserted over the guidewire. Finally, a SEMS was deployed across the ICV through the scope. The patient's obstructive symptoms were resolved without complications, and he was discharged 7 days later. This case demonstrates that in cases of malignant ileocecal obstruction where SEMS placement using conventional methods is difficult, a rescue technique using an ultra-thin scope with a single-balloon overtube may be a viable alternative.