Therapeutic Resolution of Focal, Predominantly Anastomotic Crohn’s Disease Strictures Using Removable Stents: Outcomes from a Single-Center United Kingdom Case Series

Cole, Andrew; Das, Ronit; Goddard, Andrew; Singh, Rajeev; Fraser, Catherine; Din, Said; Williams, Jessica; Lund, Jonathan; Norton, Bernard; Krishnamoorthy, Rajesh; Hearing, Stephen

Abstract

Background and Aims
Intestinal and anastomotic strictures in Crohn’s disease (CD) produce considerable morbidity The development of surgery sparing, endoscopic modalities for stricture resolution is essential. Removable stent therapy is emerging as an efficacious and safe means of stricture resolution. We present outcomes from the largest, single-center series of CD patients undergoing removable self-expanding-metal-stent (SEMS) therapy resolving focal intestinal strictures.

Methods
Symptomatic Crohn’s disease patients with were assessed with MR enterography. Identified short (≤6 cm), fibrostenotic strictures of the terminal-ileum or ileocolonic anastomoses were considered by a multidisciplinary team and put forward for stent therapy. Strictures were endoscopically examined, and impassable strictures were treated with SEMSs. The Hannaro HRC-20–080–230 partially covered SEMS was used for all treated patients. Endoscopically inaccessible or inflammatory strictures were excluded. Stent retrieval was scheduled for 7 days after insertion. Therapeutic benefit was assessed with validated inflammatory bowel disease scoring tools.

Results
Twenty-one patients underwent 23 stent episodes, with 2 patients requiring repeat therapy in the follow-up period. Most treated strictures were anastomotic (19 of 21), with a minority being de novo (2 of 21). Of those patients attending follow-up 81% (13 of 16) reported symptom improvement or resolution, with 88% (14 of 16) overall in clinical remission at follow-up. Across all stent episodes only 5 adverse events were noted (2 episodes of stent related discomfort/3 asymptomatic stent migrations). There were no direct stent adverse events such as perforation, impaction or bleeding. No patient has required stricture-related surgery in the follow-up period (Range 3-50 months).

Conclusions
In this series, removable SEMS therapy for ileal and anastomotic strictures was found to be clinically efficacious. The absence of perforation events and need for stricture related surgery are noteworthy. These results suggest that the efficacy of stent therapy in this context merits powered, head-to-head investigation with other modalities for stricture resolution.

• Journal Article Type: Article
• Acceptance Date: Jan 28, 2020
• Online Publication Date: Feb 18, 2020
• Publication Date: 2020-02
• Deposit Date: Nov 2, 2020
• Journal: Gastrointestinal Endoscopy
• Print ISSN: 0016-5107
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 92
• Issue: 2
• Pages: 344-352
• DOI: https://doi.org/10.1016/j.gie.2020.01.053
• Keywords: Gastroenterology; Radiology Nuclear Medicine and imaging
• Public URL: https://nottingham-repository.worktribe.com/output/4049673
• Publisher URL: https://www.giejournal.org/article/S0016-5107(20)30121-8/fulltext
• Related Public URLs: https://www.sciencedirect.com/science/article/pii/S0016510720301218