An Anti-migration Self-expandable and Removable Metal Stent for Crohn’s Disease Strictures: A Nationwide Study From GETAID and SFED

Abstract Background and Aims In Crohn’s disease, strictures are frequent and may require surgical resection or endoscopic balloon dilation. An anti-migration, removable and shaped self-expandable metal stent is available. We evaluated its effectiveness and safety in a real-life setting. Methods All...

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Published in:Journal of Crohn's and colitis 2021-04, Vol.15 (4), p.521-528
Main Authors: Attar, Alain, Branche, Julien, Coron, Emmanuel, Privat, Jocelyn, Caillo, Ludovic, Chevaux, Jean-Baptiste, Vuitton, Lucine, Amiot, Aurélien, Belkhodja, Hichem, Dray, Xavier, Ponchon, Thierry, Bouhnik, Yoram, Baumann, Cédric, Peyrin-Biroulet, Laurent
Format: Article
Language:English
Subjects:
Colonoscopy
Constriction, Pathologic
Crohn Disease
Female
France
Humans
Intestinal Obstruction
Life Sciences
Male
Middle Aged
Prospective Studies
Prosthesis Design
Retrospective Studies
Self Expandable Metallic Stents
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Summary:Abstract Background and Aims In Crohn’s disease, strictures are frequent and may require surgical resection or endoscopic balloon dilation. An anti-migration, removable and shaped self-expandable metal stent is available. We evaluated its effectiveness and safety in a real-life setting. Methods All centres were asked to collect retrospectively or prospectively all data on patients who had a stent for a stricture. The anti-migration stent [Hanarostent HRC-20-080-230—MITech, Seoul, South Korea] was maintained 7 days before its extraction during a second colonoscopy. Short- and long-term efficacy and safety outcomes were evaluated. Results A total of 46 patients were enrolled. Strictures were anastomotic in 73.9% of cases. The median length of the stricture evaluated by cross-sectional imaging and during colonoscopy was 3.1 ± 1.7 and 2.7 ± 1.4 cm, respectively. Immediate success [no obstructive symptom at Day 30] was reported in 93.5% of cases (95% confidence interval [CI] = [86.3; 99.9]). Sixteen patients needed a new balloon dilation [n = 8] or surgery [n = 8]. The overall success rate [obstruction-free without any intervention] was 58.7% [n = 27] after a median follow-up of 26 months [8–41 months]. No perforation occurred and three migrations were observed [6.5%]. Perianal disease (hazard ratio [HR] = 0.1 [0.02; 0.58]) and discontinuation of an immunosuppressant (0.12 [0.02; 0.86]), were associated with a lower probability of success, whereas performing imaging (HR = 5.3 [1.2; 23.5]) before stent placement was associated with success. Conclusions The anti-migration stent is safe and effective in about half of patients, with no perforation reported in this study, and has an extremely low migration rate.
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjaa208