Aims Benign anastomotic strictures, dehiscences and fistulas secondary to lower gastrointestinal
surgery are a growing problem that can be managed surgically or conservatively. Biodegradable
(BD) stents offer a prolonged dilatory effect before gradual degradation, obviates
the need of a second procedure for stent removal and promote tissue granulation. We
described a series of patients with different post-surgical complications involving
the lower gastrointestinal tract (LGIT) managed with BD stents.
Methods This was a retrospective analysis of prospectively collected cases with different
post-surgical complications (anastomotic stricture, dehiscence or fistula) of the
LGIT managed with BD stents. Data have been collected in a single endoscopic tertiary
center from May 2013 to October 2019.
Results A total of 11 patients (mean age 64±14, range 38-81; 7 males) underwent endoscopic
SX-ELLA Esophageal BD stent placement in the LIGT to treat post-surgical complications.
The series included 6 patients with colorectal anastomotic stenosis (group 1), 2 with
colorectal anastomotic complete dehiscence, 1 with colonic fistula and 2 with ileal
fistula (group 2). Five of six patients with anastomotic stenosis had been previously
undergone multiple endoscopic treatments (balloon dilation and/or ectrosurgical cutting).
Two patients with ileal fistula were also treated with over-the-scope clip (OTSC)
positioning before stent placement. The surgery was performed for a neoplastic disease
in 9 (81.8%) patients. The stent release was successful in all patients. The mean
follow-up time was 21.09±16.35 weeks (range 4-48). The clinical success rate at the
end of follow-up was 60% in group 1 (3 complete resolution; 2 stenosis recurrence;
1 neoplastic recurrence) and 100% in group 2. No complications were observed.
Conclusions Biodegradable polydioxanone stents may be an efficacious alternative in the treatment
of post-surgical strictures, fistulas and dehiscences of the lower gastrointestinal
tract. In the latter indication the tissue growth stimulated by the polydioxanone
based-stents is exploited.
