Covered Metallic Stent and Benign Colonic Strictures

• Successful stent placement [ Time Frame: Immediatly after stent insertion (one minute) ] [ Designated as safety issue: No ]
  On the first attempt with complete deployment and precise positioning of the stent at the location of the stenosis, which was confirmed by fluoroscopy
• Successful stent retrieval [ Time Frame: One minute (during colonoscopy for stent retrieval) ] [ Designated as safety issue: No ]
  Possibility of retrieval the stent with a snare or a forceps
• Occurrence of any complication during interventional endoscopy, stent retrieval and the follow-up [ Time Frame: 60 days ] [ Designated as safety issue: Yes ]
  Perforation, bleeding, migration, pain, fecal incontinence and foreign body sensation, stent impaction and hyperplastic tissue overgrowth
• Recurrence of colonic occlusion [ Time Frame: 60 days, 6 months and one year ] [ Designated as safety issue: No ]
  New episode of occlusion or subocclusion (pain with stool and gas discontinuation and imaging with cecum dilation) after stent retrieval or migration

Self-expanding metallic stent placement is a safe and effective endoscopic procedure increasingly used to relieve colonic obstruction. Fully covered metal stents (FCSEMS) and plastic stents have been recently developed to reduce both hyperplastic (non tumoral) and tumoral tissue ingrowth. These fully covered metal or plastic stents have several advantages over non-covered stents, including the possibility of retrieval and limited local tissue reaction, while providing alleviation of obstruction at possibly lower costs. Only few reports of fully covered metal stent placement in patients with benign colorectal strictures are available in the literature. The aim of this study was to assess the effectiveness of FCSEMS in the management of the colonic benign strictures.

It is a national multicentric retrospective study on the use of fully covered metal stent placement in patients with benign colorectal strictures.

Consecutive patients above 18 years of age with a symptomatic benign colonic stricture despite optimal medical and/or endoscopic dilation therapy and which required the use of a FCSEMS were included. All strictures were confirmed to be benign by histology. All details concerning previous history, origins and treatment (medical or endoscopic) of the colonic stenosis were collected from the medical file.

Senior endoscopists with an experience of more than 50 colonic stent placements performed the procedure under general propofol-induced anesthesia with the same technic (The stent was placed under fluoroscopic and videoendoscopic controls).

Patients were required after the procedure to take oral osmotic laxatives regularly. Post-stenting complications were defined as immediate (during the procedure), early (occurring ≤ 30 days) and late (> 30 days) after the procedure. Stent removal and routine follow up endoscopy were scheduled 4 to 6 weeks after placement in most patients or earlier if complications occurred.

All patients were followed up at regular intervals based on their clinical situation. A retrospective chart review was performed to analyze the long-term outcome of the patients.

Patients in universitary tertiary care center benefited from a fully covered metallic colonic stent for treatment of benign stricture

• Colonic Diseases
• Stricture
• Occlusion

Inclusion Criteria:

• patients above 18 years of age
• symptomatic benign colonic stricture despite optimal medical and/or endoscopic dilation therapy

Exclusion Criteria:

• Previous insertion or treatment of the stricture with metallic (covered or uncovered) stent