Su1540 Self-Expandable Biodegradable Stent in the Management of Refractory Benign Colorectal Strictures: Preliminary Results From a Pilot Study

Abstract

Su1540 Self-Expandable Biodegradable Stent in the Management of Refractory Benign Colorectal Strictures: Preliminary Results From a Pilot Study Alessandro Repici, Giacomo Rando, Fabio Romeo, Nico Pagano, Alessandra Carlino, Eva Vitetta, Gabriele Delconte, Giuseppe Strangio, Silvio Danese, Daniel D. Ferreira, Alberto Malesci Servizio di Endoscopia Digestiva, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy Self-expanding metal stents (SEMS) are an established treatment for palliation of malignant colorectal strictures and as a bridge to surgery for acute malignant colonic obstruction. Patients with benign colonic strictures may potentially benefit from stent placement, but little and controversial data exist for this indication. Aim of this study was to evaluate the efficacy and safety of biodegradable stents in the management of benign refractory colorectal strictures. A single center pilot study including patients with benign strictures located within 25 from anal verge refractory to mechanical or pneumatic dilation (at least 3 sessions). Exclusion criteria were: presence of concomitant fistula, suspicion of malignancy, diverticulosis, previous stent placment and stricture located too close to the anus ( 5cm). Outcome was evaluated clinically and as ability to pass through the stricture with a regular size colonoscope. Data were prospectively collected in an electronic database and follow-up was scheduled with endoscopic control after 14, 30, 90 days and afterwards at monthly interval by telephone interview. The stent used was an esophageal biodegradable stent (Ella, Czech Rep), in two different size 25 and 30 mm. Stent was placed under fluoroscopic and endoscopic control. Results: 11 consecutive patients (8M/3F, mean age 58.8y) were enrolled from September 2009. The etiologies of the stricture were: postsurgical anastomotic (n 8), radiation-induced (n 2), and Crohn’s (n 1) disease. Mean stricture length was 2.4 cm (2-4 cm). Stent placement was technically successful for all patients. No perforation occurred in the present series. Stent migration occurred in 4 patients after 4 days, 10 days, 14 days and 3 weeks respectively. One of these patients developed an acute obstruction after stent migration and underwent emergency surgery. Two patients are under periodic dilation and one was retreated with a second biodegradable stent. One patient presented with acute bowel occlusion due to fecal impaction 2 months after stent placement and was successfully treated by endoscopy. Mean follow-up was 7.5 months (range 4-14 months). Among the 7 patients who maintained the stent until its complete degradation, 5 remained asymptomatic and didn’t develop stricture recurrence. Two patients (one with radiation-induced and one with post-surgical stricture) developed symptomatic stricture recurrence and are currently treated with periodic dilation. Placement of biodegradable stent may represent a potential therapeutic alternative in patients with refractory colorectal strictures. High migration rate (36.3%) is a major drawback of this approach. The development of dedicated biodegradable colorectal stent (with anti-migration design) which better fit the colorectal anatomy could help in reducing the migration rate.