S2321 Use of a Lumen-Apposing Metal Stent for a Colo-Colonic Stricture in the Time of COVID-19

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INTRODUCTION: Anastomotic strictures are a known complication of colon resections. Risk factors include neoadjuvant chemo-radiation, anastomotic leak, diverting stoma and stapled anastomosis. Endoscopic balloon dilation is the first line intervention for anastomotic strictures but often requires several treatment sessions and associated healthcare system exposure. We describe a case of a colorectal anastomotic stricture treated with a lumen apposing metal stent (LAMS) with the purpose of decreasing frequency of endoscopic therapy during the initial outbreak of COVID-19. CASE DESCRIPTION/METHODS: A 51 year old female presented for management of a colo-colonic anastomotic stricture. She underwent a low anterior resection for stage III rectal cancer, complicated by an anastomotic leak requiring a diverting loop ileostomy. She then completed adjuvant XRT and FOLFOX therapy. She presented for evaluation 6 months after the creation of her loop ileostomy to consider reversal. During endoscopy, a severe stricture was found which could not be traversed even with a 15 Fr gastroscope. Initial dilation to 10mm with a balloon dilator was successful. One week later, the stricture was improved but still severe. A 15 mm by 10 mm LAMS was placed with the intent of decreasing the number of required procedures and healthcare system exposure during the initial outbreak of COVID-19. The stent was removed 6 weeks later, and the underlying stricture was markedly improved to a diameter of 15 mm, easily traversable with a gastroscope. The patient did not experience any complications while the stent was in place and was able to proceed with planning for ostomy reversal. DISCUSSION: Endoscopic balloon dilation is the initial intervention for anastomotic strictures. Serial balloon dilations usually require multiple procedures to achieve a durable response. With the uncertainty caused by the recent outbreak of COVID-19, many physicians and patients are looking for ways to decrease exposure to healthcare centers. Although LAMS are approved for the management of pancreatic fluid collections, they have been described as an alternative therapy for luminal GI strictures. This case demonstrates early adoption of LAMS with successful luminal dilation of an anastomotic stricture during the COVID-19 pandemic in an effort to decrease healthcare exposure and PPE use during an unprecedented time.Figure 1.: Colo-colonic anastomotic stricture prior to dilation.Figure 2.: LAMS 6 weeks after initial placement.Figure 3.: Stricture after LAMS removal.