Long-Term Management of Crohn’s Stricture Using a Self-Expanding Metal Stent: Report of Nine Year Follow-Up

Rebecca A Levine, MD, Omar Kadro, MD. William Beaumont Hospital

Self-expanding metal stents (SEMS) have proven quite effective in the treatment of malignant colorectal strictures both as a palliative measure and as a bridge to surgery. But there is no consensus regarding the role of this technology in benign disorders such inflammatory bowel disease. Intestinal obstruction is a frequent complication for patients with Crohn’s disease often leading to multiple surgical interventions and severe disability. Non-surgical strictureplasty using SEMS represents a promising alternative and has been successfully reported in sporadic cases over the last decade. However, stent migration rates are high and long-term outcomes essentially unknown. We report nine year follow-up on a patient with Crohn’s disease who underwent endoscopic stenting of a strictured ileocolonic anastomosis after failure of maximal medical therapy as well as a trial of balloon dilatation. Since the procedure, he has required no further endoscopic or surgical intervention. Colonoscopy at eight year follow-up showed the stent in place without any signs of occlusion or other complication (Figure 1). In addition, the patient has experienced no recurrent obstruction either clinically or on radiographic evaluation over the past nine years (Figures 2-4). To our knowledge this is the first report of long-term endoprosthetic management for a Crohn’s stricture without erosion, early migration or planned surgical removal. The positive results described here support the use of SEMS as a safe & durable non-surgical option for definitive management of this challenging disease.