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P176. Endoscopic treatment with self-expanding metal stents in Crohn's disease strictures

C. Loras1, L. Pardo1, F. Pérez-Roldán2, J. Espinós1, P. González2, J. Barrio3, F. Igea4, M. Pérez-Miranda3, F. González-Huix5, F. Fernández-Bañares1, M. Esteve1

1Hospital Universitari Mútua de Terrassa, Terrassa, Spain; 2Hospital General La Mancha-Centro, Alcázar de San Juan, Spain; 3Hospital Universitario Río Hortega, Valladolid, Spain; 4Hospital Rio Carrion, Palencia, Spain; 5Hospital Josep Trueta, Girona, Spain

Introduction: The stenosis in Crohn's disease (CD) is one of the most frequent local complication. It can be managed by medical, endoscopic and surgical approaches. The pneumatic dilation (with or without steroid injection) is the endoscopic treatment of choice. The stent placement has been rarely reported. Aim: To describe a new alternative in the endoscopic treatment of symptomatic short strictures in CD, by the temporary placement of metal stents.

Material and Methods: We included 10 patients with CD, from 5 hospitals, that were treated with self-expanding metallic stent for symptomatic short strictures refractory to medical and/or endoscopic treatment.

Results: We have placed 14 stents in 10 patients (7 female, 3 male; mean age 49 years; 2 ileal location and 8 ileocolic) with short stenosis (2–6 cm) located in 6 cases in colon and in 5 in the ileocolonic anastomosis. Five patients received combined immunosuppressants + biologicals and the remaining cases received monotherapy with azathioprine (4) or infliximab (1). In 2 cases, 2 stents were placed simultaneously. In all except 2 cases, previous endoscopic dilation were unsuccessful (± steroid injection) (number dilations: 1–6). Four stents were partially covered (PC) and 10 were completely covered (C) (6–9 cm length and 16–24 mm diameter). The stents were maintained from 1 to 16 weeks (median 5). The treatment was effective in 7 patients (follow-up period from 7 to 48 months; 1 case awaiting extraction). In 4 cases (2 PC and 2 C maintained 16 and 8 weeks) the removal of the stents was technically difficult due to stent impaction. Five stents migrated spontaneously. There were no major complications.

Conclusions: The placement of metallic stent is an effective and safe treatment for short strictures in CD refractory to endoscopic dilations and may be a good endoscopic alternative treatment. Despite the limited number of patients, C stent maintained over a period of 4–6 weeks, seems to be the most appropriate treatment.