Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10162
Peer-review started: March 7, 2022
First decision: April 8, 2022
Revised: April 19, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: October 6, 2022
Processing time: 203 Days and 15.3 Hours
The endoscopic management of benign short post-anastomotic ileocolonic stricture (PAICS) that is refractory to primary and secondary treatment modalities remains challenging. The lumen-apposing metal stent (LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy. LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents (FCSEMSs).
This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature. We report a life-saving technique not previously documented and the use of technology to improve patient outcomes. The six patients (median age, 75 years) suffered from vomiting, constipation and recurrent abdominal pain, with symptoms starting 23-25 wk post-surgery. The median stricture length was 1.83 cm. All six patients underwent successful and uneventful bi-flanged metal stent (BFMS)-LAMS placement for benign PAICS. All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal. According to the literature, the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding. Conversely, FCSEMS has a high migration rate (15%-50%).
The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options, allowing them to avoid more invasive surgical inter
Core Tip: The lumen-apposing metal stent has demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents. We present six cases of post-anastomotic ileocolonic strictures successfully treated with a bi-flanged metal stent (NAGI stent) and a review of the relevant literature. The long and broad flanges of the bi-flanged metal stent may reduce the migration rate and improve patient tolerance and thus may represent a suitable alternative to traditional endoscopic options, with better long-term results in the management of luminal gastrointestinal strictures longer than 10 mm and shorter than 30 mm.