Endoscopic management of Crohn's disease (CD) intestinal strictures with balloon dilation is effective; however, recurrences are frequent and require further dilations or surgery. The use of extractible metallic stents may be as effective as balloon dilation with fewer recurrences. The aim was to investigate in a prospective pilot study the feasibility and clinical effectiveness of the use of extractible stents in the treatment of CD intestinal strictures.
In two tertiary referral centers, quiescent CD patients except for obstructive symptoms associated with intestinal stenosis of less than 50 mm length on enterography were eligible for transitory stent placement, initially planned to be retrieved after 8 weeks, which was secondarily reduced to 4 weeks after patient 3.
Eleven patients (six males, five females, median age 34 years [range 18–66]) were prospectively included. The sites of intestinal stenosis were an ileocolonic anastomosis, an ileosigmoidic anastomosis, and the surgically untreated terminal ileum in eight, one, and two patients, respectively. Stent placement was technically successful in 10 patients. Obstructive symptoms were relieved in 6 out of 10 patients. Two patients needed surgery related to the procedure. Six downstream migrations were observed. Only one patient could have the stent extracted as scheduled on day 28 and remains symptom-free after 73 months of follow-up.
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. (Inflamm Bowel Dis 2012)
1Service de Gastro-Entérologie, MICI, Assistance Nutritive, Hôpital Beaujon, Clichy, France
2Département des Maladies de l'appareil digestif, Hôpital Huriez, CHRU, Lille, France
3Département Médico-chirurgical des Maladies de l'Appareil Digestif, Hôpital Lariboisière, Paris, France
Reprints: Alain Attar, MD, PhD, Service de Gastroentérologie, MICI et Assistance Nutritive, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, 100 boulevard du Général Leclerc, 92110 Clichy cedex, France (e-mail: firstname.lastname@example.org).
Received for publication 3 November 2011; Accepted 4 November 2011
Supported by a grant from the François Aupetit Association.