title: Fully covered self-expanding metal stents for refractory anastomotic colorectal strictures.
abstract: BACKGROUND
  Some patients with benign colorectal obstruction do not respond to endoscopic balloon dilation. Fully covered self-expandable metal stents (FCSEMSs) have several potential advantages over non-covered stents, including a higher likelihood of retrieval owing to limited local tissue reaction. However, the efficacy and safety of FCSEMSs in benign colorectal strictures have not yet been established.
  
  
  METHODS
  Retrospective analysis of prospectively collected data concerning patients with post-surgical benign symptomatic anastomotic colorectal strictures, refractory to endoscopic dilation and in whom FCSEMSs had been placed at our center. Technical success was defined as successful stent placement and deployment at the stricture site. Early clinical success was defined as symptom relief persisting at least for 3 days. Follow-up was based on monthly clinical evaluation and quarterly endoscopic assessment. Endoscopic stent removal was planned on the basis of clinical or endoscopic assessment. Prolonged clinical success was defined as persistent symptom relief during follow-up.
  
  
  RESULTS
  Technical and early clinical success were obtained in 16 of 16 (100%) patients. The median follow-up was 21 months. Prolonged clinical success was achieved in 9/16 (56%) cases. There was no major complication, including perforation and bleeding. Stent migration occurred in 3 (19%) cases, in two of them associated with clinical failure. The median stent diameter was significantly higher in patients with successful than in those with unsuccessful clinical outcome (26 vs. 20 mm, P = 0.006). The clinical success rate was 1/6 (17%) in patients who received a 20-22 mm stent and 8/10 (80%) in those who received a 24-26 mm stent, respectively (P = 0.035).
  
  
  CONCLUSIONS
  FCSEMSs can represent effective and safe treatment for refractory anastomotic colorectal strictures. Large diameter stents are warranted for better results.
authors.affiliation: Digestive Endoscopy Unit, Baggiovara Hospital, Viale Giardini 1355, 41100, Modena, Italy, angelocaruso@hotmail.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Caruso
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.forename: Mauro
authors.initials: M
authors.lastname: Manno
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.forename: Carmelo
authors.initials: C
authors.lastname: Barbera
authors.forename: Vincenzo Giorgio
authors.initials: VG
authors.lastname: Mirante
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D020878:Device Removal / Q000379:methods; D004867:Equipment Design; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D008670:Metals