Kasapidis P, Mavrogenis G, Mandrekas D, Bazerbachi F. Short benign ileocolonic anastomotic strictures - management with bi-flanged metal stents: Six case reports and review of literature. World J Clin Cases 2022; 10(28): 10162-10171 [PMID: 36246813 DOI: 10.12998/wjcc.v10.i28.10162]
Corresponding Author of This Article
Panagiotis Kasapidis, AGAF, FEBGH, MD, PhD, Chief Doctor, Director, Instructor, Department of Gastroenterology and Endoscopy Unit, Central Clinic of Athens, 31 Asklipiou str, Kolonaki, Athens 10680, Greece. kasapendo@yahoo.gr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Panagiotis Kasapidis, Department of Gastroenterology and Endoscopy Unit, Central Clinic of Athens, Athens 10680, Greece
Georgios Mavrogenis, Department of Gastroenterology, Mediterraneo Hospital, Glyfada, Athens 16685, Greece
Dimitrios Mandrekas, Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
Dimitrios Mandrekas, Department of Surgery, Attendant of Central Clinic of Athens, Athens 10680, Greece
Fateh Bazerbachi, CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN 56301, United States
Author contributions: Kasapidis P, Mavrogenis G, Mandrekas D and Bazerbachi F contributed to the conception and design of the study and the collection, analysis and interpretation of the data; Kasapidis P and Bazerbachi F supervised the study and drafted the manuscript; Kasapidis P and Bazerbachi F reviewed the drafted manuscript; Kasapidis P approved and submitted the final manuscript.
Informed consent statement: Written informed consent was obtained from the six patients for the publication of these case reports and accompanying images. Copies of the written consent forms are available for review upon request. Ethics approval is not required for case reports at our institution.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Panagiotis Kasapidis, AGAF, FEBGH, MD, PhD, Chief Doctor, Director, Instructor, Department of Gastroenterology and Endoscopy Unit, Central Clinic of Athens, 31 Asklipiou str, Kolonaki, Athens 10680, Greece. kasapendo@yahoo.gr
Received: March 7, 2022 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
Abstract
BACKGROUND
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).
CASE SUMMARY
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%).
CONCLUSION
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 interventions. The BFMS (NAGI stent) is longer and larger than the prototype AXIOS-LAMS, which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.
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.
