title: Fully covered self-expandable metal stent in the treatment of postsurgical colorectal diseases: outcome in 29 patients.
abstract: BACKGROUND
  Self-expandable metal stent (SEMS) placement is a minimally invasive treatment for palliation of malignant colorectal strictures and as a bridge to surgery. However, the use of SEMS for benign colorectal diseases is controversial. The purpose of this retrospective study is to evaluate the efficacy and safety of fully covered SEMS (FCSEMS) placement in postsurgical colorectal diseases.
  
  
  METHODS
  From 2008 to 2014, 29 patients with 32 FCSEMS deployment procedures were evaluated. The indications for stent placement were: 17 anastomotic strictures (3/17 presented complete closure of the anastomosis); four anastomotic leaks; seven strictures associated with anastomotic leak; and one rectum-vagina fistula.
  
  
  RESULTS
  Clinical success was achieved in 18 out of 29 patients (62.1%) being symptom-free at an average of 19 months. In the remaining 11 patients (37.9%), a different treatment was needed: four patients required multiple endoscopic dilations, 4 patients colostomy confection, one patient definitive ileostomy and three patients revisional surgery. The FCSEMS were kept in place for a mean period of 34 (range: 6-65) days. Major complications occurred in 12 out of 29 patients (41.4%) and consisted of stent migration. Minor complications included two cases of transient fever, eight cases of abdominal or rectal pain, and one case of tenesmus.
  
  
  CONCLUSIONS
  FCSEMS are considered a possible therapeutic option for treatment of postsurgical strictures and leaks. However, their efficacy in guaranteeing long-term anastomotic patency and leak closure is moderate. A major complication is migration. The use of FCSEMS for colonic postsurgical pathologies should be carefully evaluated for each patient.
authors.affiliation: Emergency Endoscopic Unit, Policlinico Umberto I, 'SAPIENZA' University of Rome, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cereatti
authors.affiliation: Emergency Endoscopic Unit, Policlinico Umberto I, 'SAPIENZA' University of Rome, Rome, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Fiocca
authors.affiliation: Unité d'Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.affiliation: Emergency Endoscopic Unit, Policlinico Umberto I, 'SAPIENZA' University of Rome, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ceci
authors.affiliation: Unité d'Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bertrand-Marie
authors.initials: BM
authors.lastname: Vergeau
authors.affiliation: Unité d'Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Tuszynski
authors.affiliation: Unité d'Endoscopie Interventionnelle, RamsayGénérale de Santé, Hôpital Privé des Peupliers, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri
authors.affiliation: Unité d'Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque, 75013 Paris, France.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
keywords: colorectum; leak; migration; postsurgical stricture; self-expandable metal stent