Direct visualization-assisted enteral stent placement in malignant colorectal obstruction: a case report

Malignant bowel obstruction caused by colorectal cancer is a common and serious clinical condition. Enteral stent placement is widely used as a palliative treatment or as a bridge to surgery. Accurate guidewire placement across stenotic segments remains technically challenging.

A 39-year-old woman with sigmoid colon adenocarcinoma presented with abdominal pain and cessation of flatus and defecation for more than 20 days. Abdominal computed tomography demonstrated sigmoid colon cancer with intestinal obstruction. Colonoscopy revealed circumferential stenosis approximately 25 cm from the anus. A direct visualization system (EyeMax, Micro-Tech, Nanjing, China) was used through the biopsy channel and advanced across the stenotic segment under direct visualization. A Jagwire was successfully passed through the stricture via the EyeMax working channel. After withdrawal of the EyeMax, a self-expandable metallic stent was deployed over the guidewire under endoscopic visualization without fluoroscopy. The procedure was successful with immediate symptom relief. A delayed fecalith obstruction occurred and was effectively treated with endoscopic fragmentation. Following the procedure, the patient resumed passage of flatus and stool, and abdominal pain was significantly relieved. One month after stent placement, the patient underwent radical resection for sigmoid colon cancer without perioperative complications. During 1-year postoperative follow-up, the patient remained asymptomatic, with no evidence of recurrent intestinal obstruction, or tumor recurrence.

The EyeMax system enables real-time intraluminal visualization, facilitating safe and accurate guidewire placement in complex colorectal strictures. This technique may reduce reliance on blind manipulation and improve procedural safety.