Stricture at the site of the ileocolonic anastomosis is a common complication in patients
with Crohn’s disease after surgical resection. In these patients, endoscopic balloon
dilation has been developed as an alternative to iterative surgery. The rate of immediate
success is excellent, but consecutive dilations are required in 50 % of cases [1]. First attempts to increase the efficacy of dilation long term by using a fully
covered self-expandable metal stent (SEMS) have failed because of early stent migration
[2]. Here we report on our preliminary experience of a new stent that includes an antimigratory
design, in patients with postsurgical ileocolonic Crohn’s disease stricture.
The Hanarostent stent (M. I. Tech, Seoul, Korea) is a through-the-scope partly covered
SEMS (labelled CE) – 80 mm long and 20 mm in diameter – with an antimigratory design
that comprises a noncovered 40-mm diameter distal (ileal) collar and a noncovered
26-mm diameter proximal (colonic) one ([Fig. 1]). In order to limit the impaction of its non-covered part, the stent is systematically
removed 7 days after placement.
Fig. 1 Anti-migratory colonic Hanarostent: a set up, b after withdrawal, c large asymmetric distal head, d proximal double lasso.
Seven patients (4 men, 3 women), median age 50 years (36 – 59), were treated between
June 2010 and June 2011. The median duration of Crohn’s disease was 20 years (14 – 29).
Five patients had a right ileocolonic resection and two a subtotal colectomy with
ileosigmoid anastomosis. The median time since last surgery was 12 years (4 – 16).
All patients had obstructive symptoms despite previous dilations (1 – 7 sessions),
with a relapse of symptoms after a median time of 5 months (1 – 41) since the last
dilation. At endoscopy and computed tomography (CT) scan, there was no evidence of
disease activity apart from the presence of an anastomotic stricture less than 5 cm
long. Four patients were receiving no treatment, and three were on maintenance therapy
with infliximab. Informed consent was obtained from all patients.
With the patients under general anesthesia, through-the-scope stenting was easily
performed ([Fig. 2]) under fluoroscopic guidance. Three patients experienced abdominal pain for 2 days.
The stent was successfully withdrawn in all patients after 7 days: it was pulled out
by the tow wire, and carefully through the colon. No migration of the stent was observed
in between. No other complications occurred. Complete relief of obstructive symptoms
was achieved in all patients. After a median time of 10 months (6 – 18), two patients
had recurrent symptoms, minor in one case, obstructive in the other, leading to a
new session of endoscopic dilation in only one of seven patients at the time of writing.
Fig. 2 Insertion of through-the-scope stent into anastomotic stricture in Crohn’s disease.
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