A 49 year-old woman with colonic inertia required total colectomy
with ileorectal anastomosis in November 2009. She subsequently developed
partial bowel obstruction requiring multiple balloon dilations of a pinpoint
anastomotic stricture.
A repeat endoscopy was performed and the stricture was first dilated
up to 10 mm with a CRE balloon dilator (Boston Scientific, Natick,
Massachusetts, USA; [Fig. 1 a, b]).
Fig. 1 Endoscopic view showing:
a the wire placed across the anastomotic stricture;
b the wire-guided balloon dilating the stricture;
c the esophageal, covered, metal stent deployed across
the stricture; and d a close-up of the stent inner lumen
post deployment.
A fully covered, metal, 18 × 80-mm esophageal
Bonastent (Standard Sci Tech Inc., Seoul, South Korea) was then deployed across
the stricture ([Fig. 1 c, d]) under
fluoroscopic guidance ([Fig. 2]). The patient
tolerated the procedure well, without any complications.
Fig. 2 Fluoroscopic image of
the metal stent deployed across the stricture showing a demonstrable waist at
its center.
She was continuing to do extremely well when she returned for
follow-up visits 1 month and 3 months later, with a barium enema showing a
patent stent. She has declined to have the stent removed because she is finally
symptom free.
This case is unusual in that an esophageal stent was used to treat a
colonic stricture. In patients with advanced malignancies, colonic stenting can
provide palliative care by relieving acute colonic obstruction
[1]. More recently, self-expanding metal stents (SEMS)
have been placed in patients with benign colorectal disease [2]. The use of SEMS may be associated with a longer lasting
dilatation and a lower rate of recurrence in cases of anastomotic stricture
[2].
The majority of the previously reported cases have used colonic
stents, either covered or uncovered [3]. However, for
rectosigmoid lesions, esophageal stents may be another useful option because
they are covered and the relatively short distance from the anus offers greater
mechanical advantage in terms of manipulation of the stents [3]
[4]. One clinical trial that
compared the migration rates of several stents in malignant colonic strictures
reported that the Bonastent had the lowest rate of migration. This was
attributed to its larger diameter and flared ends [4].
In conclusion, covered SEMS with flared ends can be used to relieve
obstructions caused by anastomotic strictures. Further experience with these
novel SEMS is required before they can be recommended for more generalized
use.
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