Self-Expanding Metal Stenting in the Management of a Benign Colonic Stricture

Jessamy, Kegan; Ozden, Nuri; Simon, Howard M.; Kobrossi, Semaan; Ubagharaji, Ezinnaya

doi:10.1159/000445185

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…The results of studies about benign strictures are difficult to interpret, as most studies involved a low number of patients and a wide variability in the type of stent implanted (uncovered, partially covered or fully covered) as well as the aetiology of the stricture [13][14][15][16].…”

Section: Self-expanding Metal Stents (Sems)mentioning

confidence: 99%

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Advances in the Treatment of Postsurgical Benign Colorectal Strictures

García¹,

Pedreño²,

DuránCampos³

et al. 2019

Endoscopy - Novel Techniques and Recent Advancements

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Postsurgical benign colorectal strictures occur in up to 20% of patients who undergo colon or rectal resection. Traditionally, treatment has been surgical, but recent decades have seen the growing importance of an endoscopic approach, particularly balloon dilatation, which is now considered the first-line treatment for these benign strictures. However, balloon dilatation is associated with a recurrence of the stricture in up to 25% of cases. When this arises, one can opt for surgery aimed at performing a reanastomosis; a new intestinal anastomosis may be technically complex or even impossible, which would result in the patient requiring a permanent colostomy, with its consequent negative impact on quality of life. Accordingly, different endoscopic approaches have been evaluated for strictures refractory to balloon dilatation, such as the implant of self-expanding metallic stents, biodegradable stents, or incisional therapy, with variable results in efficacy.

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Section: Self-expanding Metal Stents (Sems)mentioning

confidence: 99%

“…Studies have evaluated the use of stents as a bridge to surgery (as in malignant diseases) to thereby avoid having to make a stoma in the event of acute colon obstruction of benign origin [13,14]. The clinical success rate reaches 91%, with major complications in up to 38% of cases.…”

Section: Endoscopy -Novel Techniques and Recent Advancementsmentioning

confidence: 99%

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

García¹,

Pedreño²,

DuránCampos³

et al. 2019

Endoscopy - Novel Techniques and Recent Advancements

View full text Add to dashboard Cite

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“…Es existieren positive Fallberichte zur SEMS-Implantation bei Anastomosenstenosen. [73] Bei Divertikulitis mit entzündlicher Stenose sollte von einer Stentimplantation Abstand genommen werden, da das Perforationsrisiko erhöht ist. Dies scheint auch übertragbar zu sein auf CED-Patienten mit entzündlicher Aktivität und Stenose.…”

Section: Ileus Bei Benigner Obstruktionunclassified

Positionspapier der DGVS zur endoskopischen Dekompression bei akutem Ileus

et al. 2017

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In patients with ileus with dilated intestine in imaging studies, endoscopic decompression appears a feasible option. However, its use is often uncritical and without scientific evidence. Before considering endoscopic intervention, CT-imaging should differentiate between mechanical obstruction and paralytic ileus/intestinal pseudo-obstruction. Tumor diagnosis and localisation are essential because the latter determines the choice of the decompression procedure. Coecal dilatation of more than 12 cm indicates an increased risk of perforation. In patients with toxic megacolon, dilation of the transverse colon to more than 6 cm is considered critical without much prospective evidence. Endoscopic decompression has a high complication rate and should be performed electively, and not as an emergency procedure, whenever possible. The use of CO insufflation rather than ambient air is strongly recommended, as is the availability of fluoroscopy. Prior trans-nasal or oral decompression-tube placement is routinely performed, and tracheobronchial intubation frequently required. In over 90 % of patients with pseudo-obstruction, conservative treatment is successful within 24 to 48 hours, and endoscopic decompression is, therefore, unnecessary. Placement of self-expanding metal stents to decompress a tumor stenosis is considered mostly for the left colon and rectum and burdened with significant risks of perforation and stent migration. Stent impact on oncological outcome is controversial because of possible tumor cell mobilization and increased postoperative cancer recurrence rates. Surgery, as primary intervention, achieves its objective in most cases. Decompression effect by endoscopic suctioning of gas and intestinal fluid is usually transient so that it is combined with transrectal decompression tubes insertion. This paper reviews the advantages and flaws of various decompression procedures in different clinical settings.

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