Safety and efficacy of fully-covered self-expandable metal stent placement for refractory stomal stenosis

TL;DR

This study shows that placing metal stents can safely and effectively treat severe stomach narrowing that doesn't respond to other treatments.

Contribution

The study introduces fully-covered self-expandable metal stents as a novel minimally invasive treatment for refractory stomal stenosis.

Findings

All five patients had successful stent placement with no immediate complications.

Symptoms like pain and vomiting improved significantly after stent placement.

Four patients maintained improvement for up to 6 months without restenosis.

Abstract

Stomas, critical in managing various gastrointestinal conditions, can lead to complications like stomal stenosis, affecting 2% to 15% of patients and causing significant morbidity. Traditional treatments such as balloon dilation and surgical revisions often fail to provide lasting relief. This study investigated a novel, minimally invasive approach using fully-covered self-expanding metal stents (FCSEMSs) to address refractory stomal stenosis effectively.

Five patients with recurrent stomal strictures unresponsive to conventional treatments underwent stent placement. Etiologies included Crohn’s disease, ischemia, and post-surgical fibrosis. Stents were selected based on stricture characteristics, ranging from 10 to 16 mm in diameter and 6 to 10 cm in length. Technical success was defined as successful deployment without immediate complication; clinical success was defined as sustained symptom resolution during follow-up. Outcome measures included abdominal girth, pain reduction (visual analog scale), vomiting, and dietary tolerance. Follow-up periods ranged from 8 weeks to 6 months.

All procedures were technically successful. Mean abdominal girth decreased from 114 ± 4.2 cm (range 108–119) to 103 ± 3.7 cm (range 99–108). Pain scores decreased from a mean of 8 ± 1.1 to 2 ± 1.2. Vomiting, bloating, and dietary tolerance improved in most patients. No stent migration or erosions/ulcer was observed during follow-up. Four patients had follow-up to 6 months without restenosis. One patient had restenosis with successful re-stenting within a 6-month follow-up period.

FCSEMSs represent a safe and effective minimally invasive alternative for refractory stomal stenosis, with promising short-term outcomes.

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