Benign colonic strictures and fistulas are a growing problem presenting most commonly
after bowel resection. Standard treatment is with endoscopic bougies or, more usually,
balloon dilation. When these approaches are not successful, other solutions are available
and different endoscopic and surgical approaches have been used to treat fistulas.
We present an additional option – biodegradable stents – for the treatment of colonic
strictures and fistulas that have proven refractory to other endoscopic interventions.
We analyzed the results from 10 patients with either a postsurgical colorectal stricture
(n = 7) or rectocutaneous fistula (n = 3) treated with the biodegradable SX-ELLA esophageal
stent (covered or uncovered). Stents were successfully placed in nine patients, although
early migration subsequently occurred in one. Placement was impossible in one patient
due to deformity of the area and the fact that the stricture was approximately 30 cm
from the anus. The fistulas were successfully closed in all patients, although symptoms
reappeared in one patient. In the six patients who received stents for strictures,
symptoms resolved in five; in the remaining patient, the stent migrated shortly after
the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable
stents is an effective alternative in the short-to-medium term. The stent does not
have to be removed and is subject to very few complications. The drawbacks of this
approach are the need to repeat the procedure in some patients and the lack of published
series on efficacy.
