Colonic Anastomotic Stenoses and Memotherm Stent Fracture: A Report of Three Cases

Abstract

Deployment of a Memotherm colonic stent (Bard, Angiomed, Karlsruhe, Germany) across anastomotic strictures, following anterior resection, is described in three patients. Two patients presented with symptoms of colonic obstruction. Two of the patients had previously undergone unsuccessful balloon dilatation of the stricture. In the third, in addition to the anastomotic stricture, there was local tumor recurrence. Initially, stenting provided effective relief of symptoms. However, in all three patients, fracture of the stents occurred at intervals of 3-7 months after insertion. This use and complication of colonic stenting has not been reported previously.

Colorectal Stenting for Malignant and Benign Disease: Outcomes in Colorectal Stenting

“…Of nine patients who had long-term follow-up (mean follow-up, 19 months), prolonged luminal patency was 11 Crohn's disease Not reported 5 months >4.5 years 12 11 Crohn's disease Covered Z-stent 10 months >3 years 13 17 Crohn's disease Wallstent (Operation 3 weeks after procedure) 14 10 Diverticular disease Wallstent 22 mm No migration (operation 6 days after procedure) 15 18 Diverticular disease Wallstent 20 mm Migration Not available 16 18 Diverticular disease Wallstent 18 mm Migration Not available 17 19 Radiation colitis Wallstent 16 mm 3 weeks >11 months 18 20 Radiation colitis Wallstent 20 mm No migration >4 months 19 21 Granulation Wallstent 22 mm No migration >1 year 20 22 Not available Choo stent Within 3 weeks Not available obtained despite frequent stent migration. Although Odurny 16 questioned the long-term efficacy of stenting in benign strictures, this intervention seemed to provide longer relief of symptoms than balloon dilation and prevented the need for invasive surgery. Further prospective studies examining the use of stents for benign disease will need to address the issue of randomization and suitable controls such as diverting stoma and balloon dilation in patients with benign disease unsuitable for surgery.…”

“…To our knowledge, after performing a detailed literature search, only 20 patients from different case series or individual case reports have been reported to have undergone stent insertion for benign obstruction. [10][11][12][13][14][15][16][17][18][19][20][21][22] The indications and outcomes are shown in Table 2. Some of these patients had repeated sessions of balloon dilation before stent insertion but failed to maintain luminal patency.…”

Fully covered self-expandable metal stent in the treatment of postsurgical colorectal diseases: outcome in 29 patients

“…Even though some authors report that migration occurs only after successful stricture dilation [Vanbiervliet et al 2013], the majority of experts concur with the fact that migration in most cases results in treatment failure requiring additional endoscopic procedures. Moreover, cases of obstruction due to granulation tissue overgrowth at the edge of the stent, mucosal erosion and stent fracture have been described [Odurny, 2001].…”

Self-expanding metallic stents in the treatment of benign colorectal anastomotic strictures: a word of caution

“…Stents placed across benign strictures may be particularly prone to fracture [7,12]. The unique features that predispose to stent fracture include healing by fibrosis, long-term constant compressive forces and acute angulation; a more flexible stent may be less prone to this complication.…”