Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohnʼs disease intestinal strictures: A prospective pilot study

Attar, Alain; Maunoury, V.; Vahedi, Kouroche; Vernier-Massouille, G.; Setakhr, V; Bulois, P.; Colombel, Jean Fréd́eric; Bouhnik, Yoram

doi:10.1002/ibd.22844

Cited by 85 publications

(79 citation statements)

References 23 publications

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“…The authors in their literature review of 9 studies with 12 patients and 15 procedures comprising all sites of CD strictures, including terminal ileal, ileocolonic, left colic, and rectosigmoid strictures, also noted that their results were much better than those quoted in other studies, with reintervention needed in 73% of patients and complications (migration, restenosis, and perforation or fistulization) occurring in 67% of patients. In the largest prospective pilot study to date, Attar et al 12 noted that although stenting is logical on the basis of the principle of endoscopic stricturoplasty and is effective in relieving symptoms in the majority (60% in their series of ileal and ileocolonic anastomotic strictures), it is plagued by spontaneous migration in 70% of cases within days of stenting, and they recommended placing the stents for only 7 days, with planned extraction after that. Thus, there does not appear to be clear evidence either way for stenting of CD fibrostenotic small bowel, anastomotic, and colonic strictures.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Stenting of J Pouch Crohn's Stricture After Proctocolectomy

Pai

Kamiński²,

Park

et al. 2014

CRSLS

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Section: Discussionmentioning

confidence: 99%

Endoscopic Stenting of J Pouch Crohn's Stricture After Proctocolectomy

Pai

Kamiński²,

Park

et al. 2014

CRSLS

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“…Data about this management are poor. In a recent prospective pilot study including 11 patients presenting with short intestinal stenosis of less than 50 mm, self-expandable metal stent placement was technically successful in 10 patients (91%) [29] . However, the migration of the stent was secondary observed in 8 patients (80%), with persistence of obstruction in 3 patients and retrocecal abscess in 1 patient.…”

Section: Endoscopic Treatment: Stentmentioning

confidence: 99%

“…Two patients needed surgery related to the procedure. Only 1 patient could have the stent extracted as scheduled on day 28 and remains symptom-free after 73 months of follow-up, leading to a final success rate of 9% [29] . As the procedure is associated with a high rate of spontaneous migrations and thus secondary complications, a French team has proposed the use of an antimigratory stent, the Hanarostent stent (M.I.…”

Section: Endoscopic Treatment: Stentmentioning

confidence: 99%

Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Mège

2017

Dig Dis

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Background: In patients with ileo-colonic Crohn's disease (CD), the main consequence of the development of intestinal fibrosis is the occurrence of a localized symptomatic stenosis for which treatment is mandatory. Besides medical treatment, which is still considered to be ineffective against non-inflammatory fibrotic intestinal stenosis due to CD, there are 2 options for the treatment of such stenosis: endoscopic and surgical approaches. Key Messages: Endoscopic treatment includes balloon dilatation and stenting, and can be performed only on selected patients with very short stenosis. Few reports with a small sample size are available; long-term results of endoscopic treatment remain unknown, with patients being exposed to possible early recurrence of the stenosis. For this reason, intestinal resection currently remains the first option for localized symptomatic intestinal stenosis due to CD refractory to medical therapy. Laparoscopic ileocecal resection with ileocolonic anastomosis gives good short-term results, without mortality and with very low rate of morbidity. Furthermore, when the resection is shorter than 50 cm, very few functional consequences or no consequences are reported, and quality of life is improved. However, CD recurrence is frequent and can be required to redo surgery in up to 30% of the cases. In order to reduce the theoretical risk of short bowel syndrome, some surgeons have proposed strictureplasty as a more conservative approach. The concept is to treat stenosis without intestinal resection by opening the stenosis. There are different kinds of stricturoplasty, with similar reported morbidity and long-term recurrence rates than those observed with resection. Conclusions: Because no randomized study exists, it is difficult to know what the best option for symptomatic ileal stenosis in CD is. However, for a majority of patients today, ileocecal resection is the first option, strictureplasty being reserved by most of the surgeons for recurrent cases and/or multiple stenoses. It requires more experience to perform endoscopic treatment with long-term results.

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“…The 12-mm-diameter colonoscope now easily passes through the stenosis. h Endoscopic view of the stricture immediately after stent removal migration (6 patients out of 11) and complication rates of colonic fully covered self-expandable metal stents are prohibitively high [118]. Partially covered self-expandable stents, with a specific ileocolonic design, are more promising (Fig.…”

Section: Bowel Stentingmentioning

confidence: 99%

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

et al. 2014

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Crohn's disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.

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Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohnʼs disease intestinal strictures: A prospective pilot study

Abstract: Even if stenting appears an effective technique in treating symptomatic CD intestinal strictures, the procedure is associated with a prohibitively high rate of spontaneous migrations and complications.

Cited by 85 publications

References 23 publications

Endoscopic Stenting of J Pouch Crohn's Stricture After Proctocolectomy

Endoscopic Stenting of J Pouch Crohn's Stricture After Proctocolectomy

Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

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