It is routine practice to use metal stents in the treatment of
malign obstructions in the lower gastrointestinal tract [1]. However, metal stents are not suitable for benign
conditions. Recently, treatment with biodegradable stents has been implemented
for non-malignant diseases in the upper gastrointestinal tract
[2]
[3], but there is no case in the
literature reporting on the use of biodegradable stents for benign conditions
in the lower gastrointestinal tract. Here we describe a case with a benign
stricture in a colorectal anastomosis, treated with a biodegradable stent.
A 68-year-old man underwent sigmoid stoma reversal after
Hartmann’s procedure (for perforated diverticulitis). The patient
developed a symptomatic stricture in the colorectal anastomosis ([Fig. 1]), and biopsies were benign. Despite three
endoscopic dilations, the patient suffered from repeated symptomatic stricture
recurrence.
Due to significant co-morbidity, the patient was not suitable for
surgical treatment. As an alternative approach, a self-expanding biodegradable
esophageal stent (SX-Ella stent; ELLA-CS, Hradec Kralove, Czech Republic) was
chosen. The lumen of the stricture was less than 5 mm and was dilated up
to 12 mm. The biodegradable stent was deployed in the middle of the
stricture using a guide wire ([Fig. 2]). The
position of the stent was monitored 4 days later and the lumen further dilated
to 15 mm. The stent position was monitored 6 weeks after deployment; the
stent was shown to be partially reabsorbed ([Fig. 3]). The patient was still asymptomatic and a
colonoscopy revealed complete biodegradation of the stent 5 months later ([Fig. 4 a]). At this time, the lumen had
reduced to 8 mm ([Fig. 4 b]) and was
therefore dilated up to 18 mm. A follow-up was performed 2 years later,
which revealed that the patient had no clinical symptoms although the size of
the lumen had reduced.
Fig. 1 The colorectal stricture
visualized by use of: a contrast colonography (the arrow
indicates the stricture at the colorectal anastomosis) and b endoscopy. The 2-cm long advanced stricture had a lumen
less than 5 mm in diameter.
Fig. 2 Appearance of the
biodegradable stent immediately after insertion, visualized by use of:
a plain abdominal radiograph (arrows indicate the stent
in place) and b endoscopy.
Fig. 3 Endoscopic images 6
weeks after stenting showing partial biodegradation of the stent in the:
a proximal and b distal part of
the colorectal stricture.
Fig. 4 Endoscopic images 5
months after stenting, showing complete disappearance of the stent with a
patent lumen in the: a proximal and b distal part of the colorectal stricture, as well as a
hyperplastic tissue reaction.
This unique case demonstrates that treatment with biodegradable
stents is also feasible in patients with benign strictures in the lower
gastrointestinal tract.
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