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Outcomes of Endoscopic Stenting in Crohn’s Disease-Related Strictures

Bincy P. Abraham, MD, MS reviewing Chandan S, et al. Inflamm Bowel Dis 2022 Jul 26.

Fibrostenosis is a known complication of Crohn’s disease that can occur in up to 40% of patients within 10 years of diagnosis. With the ileocolonic region as the most common area for strictures, bowel resection has been the traditional treatment, but stricturoplasty can be used to treat strictures isolated to the small bowel. Endoscopically, balloon dilation and stricturotomy can help to open strictures and resolve obstructive symptoms in patients. However, this may be temporary at best, and patients will require colonoscopies with repeat procedures to prevent the recurrence of stenosis. Enteral stenting, on the other hand, may provide a sustained treatment option for patients who may be poor candidates for surgery.  

Nine studies involving 163 patients met the inclusion criteria in this systematic review and meta-analysis. Investigators evaluated biodegradable stents and partially covered, fully covered, and uncovered self-expanding metal stents (SEMS). 

Of strictures, 45% were at the ileocecal or ileocolic anastomosis, and the length ranged from 2 mm to 90 mm. Pooled rates of the overall outcomes showed 93% for technical success and 61% for clinical success, with 11% requiring repeat stenting. The total pooled rate for postprocedure adverse events was 16%. Adverse events included proximal stent migration (6%), abdominal pain (18%), and perforation (3%). Spontaneous distal stent migration occurred in 44% of patients; the majority (68%) occurred with the fully covered SEMS, and only 4.3% were with partially covered SEMS.


Comment:

This analysis provided data indicating that stents can be used to treat fibrostenotic Crohn’s disease with high technical and clinical success rates but with some possibility of postprocedure adverse events. Based on lower rates of stent migration with partially covered SEMS, choosing to use this type of stent over a fully covered one should be considered in patients with Crohn’s disease. With almost half of our patients requiring subsequent surgery despite endoscopic dilation, endoscopic stenting may provide a nonsurgical option that may prolong or prevent surgical resection for our patients with fibrostenotic Crohn’s disease.

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Bincy P. Abraham, MD, MS

Bio and Disclosures

Citation(s):

Chandan S, Dhindsa BS, Khan SR, et al. Endoscopic stenting in Crohn's disease-related strictures: a systematic review and meta-analysis of outcomes. Inflamm Bowel Dis 2022 Jul 26. (Epub ahead of print) (https://doi.org/10.1093/ibd/izac153)