Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas

Abstract

Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

“…Thus, prior dilatation of the stricture is often necessary. The release device measures 75 cm, which limits its use in proximal colon strictures [23], though this may be feasible with the use of overtubes.…”

“…Little evidence exists about the use of biodegradable stents in the treatment of benign postsurgical strictures. Most reports concern clinical cases [24,25] or series with a low number of patients [23,26]. The stricture is resolved in up to 45% of cases [26].…”

Endoscopic management of postoperative fistulas and leaks

“…For these reasons, successful colonic stent placement is less commonly reported. Recently, successful closure of colonic fistula was demonstrated using biodegradable esophageal stent 64 ; however, it is not available for clinical use in the US.…”

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

“…Biodegradable stents may be used for treatment of colonic strictures in the shortto-medium term. 47 These are made of synthetic polymers such as polyglycolide or copolymers such as polydioxanone and have a cumbersome delivery system through an overtube over a guidewire. Biodegradable stents were initially developed for management of benign esophageal strictures, with the theoretical advantage of not requiring stent retrieval; however, similar to SEMSs, they are associated with migration.…”