Can a modified esophageal stent be useful in the treatment of nonresponsive benign colonic anastomotic stenosis?

A 77-year-old woman with history of anterior rectal resection for neoplasia in 1998, followed by chemoand radiotherapy, was referred to our unit because of an increase in subocclusive episodes (1–2 times a week) over the previous 5 months, due to a stenosis extending to 5 cm above the colorectal anastomosis. The patient had previously undergone several pneumatic dilation procedures for anastomotic stenosis, with substenosis of the colon above, following radiotherapy. A computed tomography scan showed a benign stenosis of the anastomosis extending to 5 cm of the colon above, with wall thickening from the development of fibrotic tissue after radiotherapy. We performed a colonoscopy to confirm the clinical scenario; the colorectal anastomosis was located 4 cm from the anal verge (▶Fig. 1). We planned to place a modified, esophageal, large-diameter, fully covered, self-expandable metal stent (FCSEMS), with an anti-migration system and proximal head (26mm diameter, 100mm length, 34mm head; Taewoong Medical, Gyeonggi-do, South Korea). Under deep sedation, the patient underwent lower endoscopy with a gastroscope. The proximal and the distal ends of the stricture were marked with a submucosal injection of radiopaque contrast medium. A guidewire (Jagwire; Boston Scientific, Marlborough, Massachusetts, USA) was advanced beyond the stenosis and the FCSEMS was placed over the wire (▶Fig. 2, ▶Video1). The patient was discharged the day after the procedure. The stent was removed 4 weeks later with a rat tooth forceps, and complete resolution of the stenosis could be observed (▶Video1). No adverse events were observed during the placement or removal of the stent. At 1 month followup, the patient was free of subocclusive symptoms. In conclusion, the large-bore, modified, esophageal FCSEMS can be a valid alternative in the treatment of colorectal stenosis that is nonresponsive to other endoscopic treatments.