Biodegradable stents for the treatment of bowel strictures in Crohn's disease: technical results and challenges

Background and study aims: In patients with Crohn’s disease, the idea of biodegradable stents for treatment of bowel strictures with limited effect of endoscopic balloon dilation is tempting and initial results have been promising. The aim of this study was to evaluate the technical and clinical success of biodegradable stents for treatment of inflamed Crohn’s strictures refractory to endoscopic balloon dilatation.

Patients and methods: Consecutive patients treated with biodegradable stents due to Crohn’s disease and inflamed bowel strictures refractory to endoscopic balloon dilatation were included. Technical and clinical success were evaluated.

Results: Six patients were included in the study. Technical success was obtained in five patients (83 %). Clinical success was limited to one patient (20 %); failure was observed due to mucosal overgrowth (n = 2), stent migration (n = 1), and stent collapse (n = 1).

Conclusions: In Crohn’s disease, it is technically feasible to treat bowel strictures with biodegradable stents. However, we have stopped using biodegradable stents due to lack of clinical success and side effects such as mucosal overgrowth and stent collapse.

• References

• 1 Dignass A, Van Assche G, Lindsay JO et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohn's Colitis 2010; 4: 28-62
• 2 Thienpont C, D'Hoore A, Vermeire S et al. Long-term outcome of endoscopic dilatation in patients with Crohn's disease is not affected by disease activity or medical therapy. Gut 2010; 59: 320-324
• 3 Karstensen JG, Hendel J, Vilmann P. Endoscopic balloon dilatation for Crohn's strictures of the gastrointestinal tract is feasible. Dan Med J 2012; 59: A4471
• 4 Ferlitsch A, Reinisch W, Puspok A et al. Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures. Endoscopy 2006; 38: 483-487
• 5 Attar A, Maunoury V, Vahedi K et al. Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohn's disease intestinal strictures: a prospective pilot study. Inflamm Bowel Dis 2012; 18: 1849-1854
• 6 Branche J, Attar A, Vernier-Massouille G et al. Extractible self-expandable metal stent in the treatment of Crohn's disease anastomotic strictures. Endoscopy 2012; 44 Suppl 2 UCTN: E325-E326
• 7 Loras C, Perez-Roldan F, Gornals JB et al. Endoscopic treatment with self-expanding metal stents for Crohn's disease strictures. Aliment Pharmacol Ther 2012; 36: 833-839
• 8 Rejchrt S, Kopacova M, Brozik J et al. Biodegradable stents for the treatment of benign stenoses of the small and large intestines. Endoscopy 2011; 43: 911-917
• 9 Roldan PF, Gonzalez CarroP, Villafanez GarciaMC et al. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas. Endoscopy 2012; 44: 297-300
• 10 Karstensen JG, Vilmann P, Hendel J. Successful endoscopic treatment of a 12-cm small-bowel Crohn stricture with a custom-made biodegradable stent. Endoscopy 2014; 46: E227-228
• 11 Krokidis M, Burke C, Spiliopoulos S et al. The use of biodegradable stents in malignant oesophageal strictures for the treatment of dysphagia before neoadjuvant treatment or radical radiotherapy: a feasibility study. Cardiol Intervent Radiol 2013; 36: 1047-1054
• 12 Saritas U, Ustundag Y. Biodegradable stents: another big step in the field of non-surgical therapy for fibrostenotic Crohn's disease. Endoscopy 2012; 44: 435 ; author reply 436
• 13 East JE, Brooker JC, Rutter MD et al. A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of Crohn's strictures. Clinical gastroenterology and hepatology : the official clinical practice. J Am Gastrointest Assoc 2007; 5: 1065-1069
• 14 Hendel J, Karstensen JG, Vilmann P. Serial intralesional injections of infliximab in small bowel Crohn's strictures are feasible and might lower inflammation. United European Gastroenterol J 2014; 2: 406-412
• 15 Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc 2013; 78: 819-835