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

Abstract

Background: Self-expandable metal stent (SEMS) placement is a minimally invasive treatment for palliation of malignant colorectal strictures and as a bridge to surgery. However, the use of SEMS for benign colorectal diseases is controversial. The purpose of this retrospective study is to evaluate the efficacy and safety of fully covered SEMS (FCSEMS) placement in postsurgical colorectal diseases. Methods: From 2008 to 2014, 29 patients with 32 FCSEMS deployment procedures were evaluated. The indications for stent placement were: 17 anastomotic strictures (3/17 presented complete closure of the anastomosis); four anastomotic leaks; seven strictures associated with anastomotic leak; and one rectum-vagina fistula. Results: Clinical success was achieved in 18 out of 29 patients (62.1%) being symptom-free at an average of 19 months. In the remaining 11 patients (37.9%), a different treatment was needed: four patients required multiple endoscopic dilations, 4 patients colostomy confection, one patient definitive ileostomy and three patients revisional surgery. The FCSEMS were kept in place for a mean period of 34 (range: 6-65) days. Major complications occurred in 12 out of 29 patients (41.4%) and consisted of stent migration. Minor complications included two cases of transient fever, eight cases of abdominal or rectal pain, and one case of tenesmus. Conclusion: FCSEMS are considered a possible therapeutic option for treatment of postsurgical strictures and leaks. However, their efficacy in guaranteeing long-term anastomotic patency and leak closure is moderate. A major complication is migration. The use of FCSEMS for colonic postsurgical pathologies should be carefully evaluated for each patient.

Biological behavior exploration of a paclitaxel-eluting poly-l-lactide-coated Mg–Zn–Y–Nd alloy intestinal stent in vivo

“…However, the application of these stents is related to several common problems, including new stricture formation, perforation, migration, tissue ingrowths, and repetitive endoscopy. [2][3][4][5][6] To avoid the complications of permanent metal and plastic stents, biodegradable polymer alloy stents have recently been introduced.…”

Colonic Self-Expandable Metal Stent Placement: Seven-Year Experience

“…30. gün mortalite %9 olup bunun yarısından stent ilişkili komplikasyonlar sorumludur. Geç komplikasyonlar (>30 gün); reobstrüksiyon (tümör ingrowth-overgrowth'u, kaçaklarının tedavisi son yıllarda daha sık başvurulan bir yöntem olmuştur (6)(7)(8)(9)(10)(11)(12)(13)(14). Bizim çalışmamızda bir hastaya anastomoz kaçağından dolayı metal stent konulmuştu.…”

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

“…The high rate of recurrence of postsurgical strictures after balloon dilatation, around 25%, especially in long strictures, with a technique not exempt from complications, has led to multiple studies assessing the role of SEMS [15,[17][18][19][20], although all involved just a few patients.…”

“…Unlike balloon dilatation, stents apply a constant prolonged radial force on the stricture, due to the natural tendency of nitinol to recover its original shape once released. This quality permits definitive remodelling of the stricture, and covered stents also afford the possibility of sealing anastomotic leaks when they are associated with the stricture [17,18].…”

“…The immediate clinical efficacy reported in various studies ranges from 36 to 81% [15,17,[19][20][21] and improves with larger diameter stents [19]. However, they are associated with a high rate of complications, mainly migration in 19-63% of cases [17,19,21], which, if early, necessitates additional treatment of the stricture, reobstruction due to hyperplastic reaction in the extremes or stool impaction, necrosis due to pressure, bleeding, anal pain or perforation in up to 28% of cases.…”