Clinical Endoscopy

Review

Endoscopic strategy and covered self-expandable metal stents for malignant hilar biliary obstruction: Tae Hoon Lee, Jong Ho Moon, Sang-Heum Park; Received September 19, 2025 Accepted October 16, 2025 Published online December 3, 2025; DOI: https://doi.org/10.5946/ce.2025.343 [Epub ahead of print]

Abstract PDF PubReader ePub: Malignant hilar biliary obstruction (MHO), most commonly caused by cholangiocarcinoma, is an aggressive condition with a poor prognosis. Because most patients with MHO are unsuitable for primary surgical resection at presentation because of advanced age or comorbidities, palliative biliary drainage is essential to relieve obstructive jaundice and improve the quality of life. Endoscopic drainage has become the preferred palliative approach, with the choice between plastic and metal stents depending on subsequent therapeutic plans, such as systemic chemotherapy or local ablative therapies. Among biliary stents, self-expandable metal stents (SEMSs) are widely used, typically in their uncovered form. However, unlike plastic stents, uncovered SEMSs cannot be removed once deployed, and endoscopic revision is technically challenging. To improve stent patency and facilitate removability, covered SEMSs (CSEMSs) were developed, and are now commonly used in distal malignant biliary obstruction. Nevertheless, in advanced MHO, the primary use of CSEMSs remains controversial. This review summarizes recent endoscopic strategies for advanced MHO, the evolution of CSEMSs, their clinical outcomes, current limitations, and future directions.

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Original Article

Colonic stenting for colorectal cancer: stoma avoidance with acceptable radiation exposure: Christopher Robert Smith, Michael Adesida, Gibran Timothy Yusuf, Hesham Soliman, Mintimer Negametzyanov, Efthymios Ypsilantis; Clin Endosc 2025;58(5):738-743. Published online July 7, 2025; DOI: https://doi.org/10.5946/ce.2024.317

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Self-expanding metal stents (SEMS) are used to manage colonic obstruction for palliative decompression or as a bridge to curative surgery and are typically placed under fluoroscopic guidance. This study aimed to quantify the radiation exposure associated with colonic stenting for obstructing colorectal cancer (CRC) and compare it with established diagnostic reference levels (DRLs) for similar fluoroscopy-guided procedures. Secondary outcomes included procedural success rates, stent patency, stoma rates, and complications.
Methods
This retrospective observational study was conducted at a single district general hospital and included all the patients who underwent colonic stenting for CRC between March 2016 and February 2021. Radiation exposure was measured using the kerma-area product (KAP) in µGy*m² and fluoroscopy time in minutes, obtained from existing electronic patient records.
Results
Fifty-two stenting procedures were performed in 47 patients. Median KAP was 1,373.7 (interquartile range [IQR], 584.4–3,185.2) µGy*m², and fluoroscopy time was 8.9 (IQR, 4.4–12.6) minutes. Technical and clinical success was achieved in 86.5% of the cases. In palliative cases, 88.9% of patients maintained stent patency until death. The complications included perforation (5.8%) and stent migration (3.9%). Laparoscopic surgery was performed in 70% of curative cases.
Conclusions
Radiation exposure during colonic stenting is within acceptable ranges and comparable to that of other fluoroscopy-guided procedures. These findings support the listing of colonic stenting in future National DRLs in the United Kingdom.

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Review

Role of fully covered metal stents in the management of chronic pancreatitis: Younghun Jeon, Hoonsub So, Sung Jo Bang; Clin Endosc 2025;58(5):646-652. Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.349

Abstract PDF PubReader ePub: Chronic pancreatitis (CP), a progressive inflammatory disease that results in irreversible pancreatic damage, is often complicated by ductal strictures and debilitating pain. Fully covered self-expandable metal stents (FCSEMS) have emerged as significant innovations in the endoscopic management of refractory pancreatic duct strictures. This review synthesizes recent evidence highlighting the benefits and limitations of FCSEMS, such as superior patency, reduced need for reinterventions, and effective symptom relief compared to traditional plastic stents, alongside risks, such as stent migration and de novo strictures. A comparison with plastic stents and an algorithm for pancreatic duct stricture management are provided. Regional variations in clinical guidelines from the United States, Europe, Japan, and Korea reflect diverse approaches to integrating FCSEMS into practice. Emerging innovations in stent technology are promising for improving CP management outcomes.

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Original Article

Fabrication and mechanical testing of polydioxanone hook cross biodegradable self-expandable enteric stent: impact of fabrication density and mechanical properties of the stent: Tanyaporn Chantarojanasiri, Juthamas Ratanavaraporn, Saran Keeratihattayakorn; Clin Endosc 2025;58(4):586-594. Published online April 28, 2025; DOI: https://doi.org/10.5946/ce.2024.252

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: The mechanical properties of biodegradable stent when fabricated using different number of pins per row of fabrication has been limited. We compared the radial compressive force of polydioxanone (PDO) stent that was fabricated in hook and cross manner, using 13, 17 and 19 pins per row and measure the radial compressive force and ex vivo deployment.
Methods
The PDO stents fabricated by the in-house aluminum mandrel were tested for radial force using plate compression until the stent achieved 50% strain. The relationship between compression force and %strain was calculated. Ex vivo testing of stent expansion against short segment stricture was performed in a pig small intestine compared between PDO hook cross PDO stent and braided metallic stent.
Results
The stent shortening of 16.40%, 31.20% and 19.24% was observed in 13-, 17- and 19-pin-per-row, respectively. The maximum force to achieve 50% strain were 0.503, 1.168 and 1.008 N for 13, 17 and 19 pins per row, respectively. The stent fabricated using hook and cross pattern demonstrated higher conformability to anatomical stricture when compared with braided stent.
Conclusions
PDO stent fabricated using 17 pins per row demonstrated highest radial force when compared with 13 and 19 pins per row.

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Systematic Review and Meta-analysis

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis: Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari; Clin Endosc 2025;58(2):240-252. Published online February 3, 2025; DOI: https://doi.org/10.5946/ce.2024.120

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

Citations

Citations to this article as recorded by

Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra‐thin Scope and Single‐balloon Overtube
Takato Maeda, Norihiro Hanabata, Shohei Igarashi, Masayoshi Ko, Koji Shimaya, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba
DEN Open.2026;[Epub] CrossRef
Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef
Minimally invasive, maximum impact: advances in the application of colonic stents
Filippos Koutroumpakis, Emmanuel Coronel
Current Opinion in Gastroenterology.2026; 42(1): 19. CrossRef
Embracing minimally invasive approaches to colorectal cancer resection
Nan Zun Teo, James Weiquan Li, James Chi Yung Ngu, Tiing Leong Ang
Singapore Medical Journal.2025; 66(Suppl 1): S38. CrossRef

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Original Article

Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea: Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee; Clin Endosc 2024;57(6):790-797. Published online September 23, 2024; DOI: https://doi.org/10.5946/ce.2024.110

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

Citations

Citations to this article as recorded by

3D Printing in Gastroenterology
Jack T. Gardner, Steve P. Bensen
Journal of Clinical Gastroenterology.2026; 60(1): 28. CrossRef
Novel minimally invasive strategies for achieving source control in intra-abdominal infections
Clayton Wyland, Desmond Zeng, Robert G. Sawyer
Current Opinion in Critical Care.2025; 31(2): 228. CrossRef
Comments on ‘Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea’
Dae Jin Jung, Gwang Ha Kim
Clinical Endoscopy.2025; 58(2): 334. CrossRef
Three-Dimensional-Printed Gastrointestinal Tract Models for Surgical Planning and Medical Education: A Systematic Review
Jing Lei, Lisa B. G. Tee, Krish Ragunath, Zhonghua Sun
Applied Sciences.2025; 15(13): 7384. CrossRef

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Review

Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions: Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia; Clin Endosc 2024;57(5):588-594. Published online July 9, 2024; DOI: https://doi.org/10.5946/ce.2023.169

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