Letter

[kiny]

I thought it was interesting, stenting is used so people can avoid surgery by placing something that keeps the intestine open and it can be removed later down the line I believe. Maybe someone is more familiar with it. It's basically a hollow cylinder after it's placed, like a pipe I guess.

http://onlinelibrary.wiley.com/doi/10.1111/apt.12206/full

"Gastroenterology Center of the Second Affiliated Hospital, Nanjing Medical University, Nanjing, China

Sirs,

We read with great interest the article by Loras et al.,[1] in which they demonstrated that stenting was an effective treatment for Crohn's disease intestinal strictures, but associated with a high rate of migration. At present, there have been several studies reporting that stents may be useful in the treatment of Crohn's disease strictures, but with migration, a common complication.[2, 3]

Some methods have been used to overcome this defect. A novel stent with an antimigratory design was developed by Branche et al.[4] They explored this new stent in seven patients with Crohn's disease anastomotic strictures, and complete relief of obstructive symptoms was achieved in all patients without migration of the stent. Another method of antimigration is clip placement. Some researchers anchored the upper flare of the stent, using an endoscopic clip, in the management of oesophageal diseases, and the results showed that clip placement could significantly reduce stent migration.[5] The clip method may also be useful for antimigration of stents in the treatment of Crohn's disease strictures.

Compared with metallic stents, the biodegradable stent seems to be a better way of treating Crohn's disease stenoses, with the advantages of mild mucosal hyperplastic reaction, longer patency and no requirement of subsequent removal.[6] It has been reported that epithelial hyperplasia was not observed during the follow-up period after endoscopic insertion of a biodegradable stent in patients with stenosing Crohn's disease.[7] Moreover, Jeon et al.[8] have reported that metal stents coated with paclitaxel caused very little tissue reaction of oesophageal mucosa, in contrast to nondrug-eluting stents. These drug-eluting metal stents may also be useful in Crohn's disease.

In summary, with the development of novel gastrointestinal stents, stents may become more effective and safer in stricturing Crohn's disease."



"We are grateful for the interest and comments of
Tang et al. about our article.1 However, as we mentioned
in the article,2 migration is not considered a complication,
but an incident due to the resolution of the stenosis.
Although it occurred in 84.5% (11/13) of the cases,
all the migrations could be treated on an outpatient
basis.
We are not sure that the novel stent with antimigratory
design based on a partially covered stent system"

 

[Moe.]

Heard about this. Seems like surgery will be in the past soon

 

[rollinstone]

Heard about this. Seems like surgery will be in the past soon

I hope you are right,

 

[Jam300]

Interesting idea, new to me as well!

 

[Mark in Seattle]

I notice that kiny posted the letter to the author of the study, and then below the letter is posted part of the author's reply, but a portion of the author's reply is cut due to the on-line publication cutting off the article in the middle. Anyway, here is the full author reply along with the link to the 2nd half of the author's reply (http://onlinelibrary.wiley.com/doi/10.1111/apt.12211/pdf)

SIRS, We are grateful for the interest and comments of
Tang et al. about our article.1 However, as we mentioned
in the article,2 migration is not considered a complication,
but an incident due to the resolution of the stenosis.
Although it occurred in 84.5% (11/13) of the cases,
all the migrations could be treated on an outpatient
basis.
We are not sure that the novel stent with antimigratory
design based on a partially covered stent system
could be considered a good option to avoid migration.
The impaction of stents occurred frequently in our
study (50%) using a type of partially covered stent. By
contrast, a 9.5% rate of impaction was found using
fully covered stents. In any case, it should be taken into
account that the risk of impaction seems to be related
to the time of stent placement, being probably shorter
with partially covered stents compared with fully covered
stents.
Regarding biodegradable stents, their use in stenosis
did not seem to be very effective because of the low
strength to revert the stenosis.4, 5 The results in the only
study performed in Crohn’s disease (CD) patients6 are
not encouraging. In addition, technical difficulties for
more proximal stenoses are pre-empted due to the
necessity of a special introduction system for stent insertion
through a balloon overtube.
We agree that it is necessary to develop specific stents
to treat stenosis in CD and to compare between different
types of stents to know which type achieves the best
results.

 

[Mark in Seattle]

Here is the abstract for the original study in which 17 patients, most of whom had failed balloon endoscopic dilation, received stents. And here is the link for the full-text pdf.

http://onlinelibrary.wiley.com/doi/10.1111/apt.12039/pdf


SUMMARY
Background
Balloon dilation (with or without steroid injection) is the endoscopic treatment
of choice for short strictures in Crohn’s disease (CD). The placement of a stent
has only rarely been reported in this setting, and it may be a good alternative.
Aim
To describe the efficacy of temporary placement of a self-expanding metallic
stent (SEMS) in the endoscopic treatment of symptomatic strictures in CD.
Methods
We included 17 CD patients treated with SEMS (4 partially covered SEMS
and 21 fully covered SEMS) for symptomatic strictures refractory to medical
and/or endoscopic treatment.
Results
We placed 25 stents in 17 patients with stenosis (<8 cm), in the colon and
in the ileocolonic anastomosis. In two cases, two stents were placed in the
same endoscopic procedure. All except three cases had previously been
unsuccessfully treated with endoscopic dilatation. The stents were maintained
for an average of 28 days (1–112). The treatment was effective in
64.7% of the patients after a mean follow-up time of 60 weeks (5–266). In
four cases, removal of the stents was technically difficult due to stent
impaction (moderate adverse events-AEs) and one patient had a proximal
stent migration requiring delayed surgery (severe AE).
Conclusion
The placement of self-expanding metallic stent in Crohn’s disease maintained
over a period of 4 weeks is a safe, effective treatment for strictures refractory
to medical treatment and/or balloon dilatation, and might be an alternative
endoscopic treatment in these patients.