P608 New anti-migration extractible metal stents for Crohn's disease strictures: a nationwide GETAID-SFED cohort study
Attar A.*1, Branche J.2, Coron E.3, Privat J.4, Caillo L.5, Chevaux J.-B.6, Vuitton L.7, Amiot A.8, Belkhodja H.9, Buisson A.10, Dray X.11, Jerber L.12, Ponchon T.13, Bouhnik Y.1, Peyrin-Biroulet L.6
1Hopital Beaujon, Gastro-enterologie - MICI- Assistance Nutritive, Clichy la Garenne, France 2Centre Hospitalier Régional Universitaire de Lille, Gastroenterology Department, Lille, France 3Institut des Maladies de l'Appareil Digestif (IMAD), Endoscopie Digestive, Nantes, France 4Centre Hospitalier de Vichy, Service de Gastroentérologie, Vichy, France 5CHU University Hospital, Department of Hepatology and Gastroenterology, Nîmes, France 6CHU Nancy, Department of Gastroenterology and Hepatology, Vandoeuvre-Lès-Nancy, France 7CHU Besancon, Department of Gastroenterology and Hepatology, Besançon, France 8CHU Henri Mondor, Department of Gastroenterology, Creteil, France 9CH Lyon Sud, Gastroenterology Department, Lyon, France 10CHU Estaing, Department of Digestive and Hepatobiliary Medicine, Clermont-Ferrand, France 11APHP St. Antoine Hospital, Department of Gastroenterology and Nutrition, Paris, France 12GETAID, Hospital Saint Louis, Department Of Gastroenterology, Paris, France 13Hospital Edouard Herriot, Department of Gastroenterology and Hepatology, Lyon, France
In Crohn's disease (CD), strictures are frequent and may require surgical resection or endoscopic balloon dilation. Full covered metal stenting has been abandoned due to the high migration rate. A new anti-migration shaped self-expandable and extractible metal stent (SEEMS) is available. We evaluated its efficacy and safety in a real life cohort.
All GETAID and SFED centers were asked to collect retrospectively or prospectively all data on patients who had a SEEMS for a Crohn's disease stricture. The SEEMS (Hanarostent HRC-20-080-230 – MITech, distributed by Life Partner Europe) was maintained 7 days before its extraction during a second colonoscopy. Short- and long-term outcomes were evaluated.
38 patients were enrolled in the study between June 2015 and October 2016 Mean age was 47 years, and 61% were men. CD strictures were anastomotic and unique in 68% of cases. The median (± SE) length of the stricture evaluated by cross-sectional imaging and during colonoscopy was 3±1.9 and 2±1.4 cm, respectively. Immediate success (no obstructive symptom at day 30) was reported in 79% of cases. Among them, 6 (20%) and 4 (13%) patients needed a new balloon dilation or surgery during follow-up, respectively. 42% of patients were obstruction-free without any intervention after a mean follow-up of 18 months (range, 1–58). No perforation occurred and 2 migrations were observed (5%).
SEEMS is safe, with no perforation reported in this study, and has a very low migration rate. Whether SEEMS is superior to standard balloon dilatation will require additional investigation.