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 patients with CD undergoing removable self-expanding metal stent (SEMS) therapy to resolve focal intestinal strictures.

Methods

Patients with symptomatic CD were assessed with magnetic resonance enterography. 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 examined endoscopically and impassable strictures were treated with SEMSs. The Hanaro HRC-20-080-230 partially covered SEMS was used for all 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); 2 of 21 were de novo. Of those patients attending follow-up, 81% (13 of 16) reported symptom improvement or resolution; 88% (14 of 16) were 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-related 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.

中文翻译：

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使用可移动支架治疗局灶性，主要是吻合口克罗恩病狭窄的治疗方法：英国单中心病例系列的结果。

背景和目标

克罗恩氏病（CD）的肠道和吻合口狭窄会引起很大的发病率。开发用于狭窄解决方案的节省手术的内窥镜模式至关重要。可移动支架疗法正在成为一种有效且安全的狭窄解决方法。我们介绍了正在接受可移动的自扩张金属支架（SEMS）治疗以解决局灶性肠狭窄的最大，单中心CD患者的结局。

方法

有症状CD的患者通过磁共振肠造影进行评估。多学科研究小组考虑了末端回肠的纤维狭窄狭窄（≤6cm）或回结肠结肠吻合术，并提出了支架治疗方案。在内窥镜下检查狭窄部位，并用SEMSs治疗无法逾越的狭窄。所有患者均使用Hanaro HRC-20-080-230部分覆盖的SEMS。排除内镜无法接近或发炎的狭窄。支架置入后计划7天。用经过验证的炎症性肠病评分工具评估治疗效果。

结果

21位患者经历了23次支架发作，其中2位患者在随访期间需要重复治疗。多数狭窄均是吻合的（21个中的19个）。21的2是no novo。在接受随访的患者中，有81％（16名患者中的13名）报告了症状改善或缓解。88％（16/14）随访时临床缓解。在所有支架事件中，仅记录到5例不良事件（2例与支架相关的不适，3例无症状的支架迁移）。没有直接的与支架相关的不良事件，例如穿孔，撞击或出血。在随访期（3-50个月）内，没有患者需要进行与狭窄相关的手术。

结论

在该系列中，发现用于回肠和吻合口狭窄的可移动SEMS治疗在临床上是有效的。值得注意的是，没有发生穿孔事件，需要进行与狭窄相关的手术。这些结果表明，在这种情况下，支架治疗的有效性值得采用动力头对头调查以及其他方法来解决狭窄问题。