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ENDOSCOPIC THERAPY WITH FULLY COVERED METAL STENTS FOR MANAGEMENT OF POST COLORECTAL SURGERY ANASTOMOTIC COMPLICATIONS: A SINGLE CENTER RETROSPECTIVE COHORT STUDY
Rahul Karna
*, Cyrus Jahansouz, Paolo Goffredo, Nabeel Azeem, Stuart K. Amateau
University of Minnesota Medical School, Minneapolis, MN
Introduction: Colorectal surgery often involves creation of ostomy to divert fecal contents, thereby allowing fresh surgical anastomosis site to heal. However, anastomotic strictures or leaks may occur in up to 30% patients complicating successful ostomy takedown. Endoscopic therapy with placement of stents, be they lumen apposing metal stents (LAMS) or fully covered self-expanding metal stents (FCSEMS), allows minimally invasive endoscopic therapy of post-surgical anastomotic leaks and strictures, possibly obviating the need for morbid repeat surgeries or prolonged percutaneous drains, and ultimately allowing early ostomy takedown. To date, utilization of fully covered metal stents (FCMS) for management of post-surgical lower gastrointestinal anastomotic complications as a bridge to ostomy reversal is poorly studied.
Methods: We conducted a single center retrospective study of all patients who underwent fully covered metal stent placement for post-colorectal surgical anastomotic complications from 2021 to 2024. The primary outcome was successful ostomy take down after placement of metal stent. Secondary outcomes were resolution of stricture as per endoscopist discretion based on the appearance of the stricture in relation to the rest of the lumen and drain removal in case of anastomotic leaks. Descriptive statistics was performed.
Results: A total of 9 patients, 6 females, with a median age of 57 years were included.
Table 1 shows baseline characteristics of the included cohort. Median time from colorectal surgery to stricture diagnosis was 77 days (58-112) while leak was diagnosed in 1 patient after 5 days. Length of stricture was <10 mm in all patients except one who had 35 mm stricture. Median width of stricture was 2 (1.5-4) mm. Stricture management required LAMS in 75% (6/8) patients, while the remaining 25% (2/8) underwent LAMS with coaxial FCSEMS placement. Indwell time of first LAMS before follow up colonoscopy was 42 (24-58.5) days. LAMS was displaced/migrated in 37.5% (3/8) on follow up colonoscopy. Total LAMS indwell time till resolution of stricture was 56 (24-82) days. All patients (8/8) had stricture resolution at time of last colonoscopy. FCSEMS was used successfully for a patient with anastomotic leak allowing drain removal after 45 days. LAMS allowed ostomy take down in 87.5% (7/8) patients after a median interval of 84 (83-109) days, while 1 patient is planned for ostomy takedown. Patients were followed for median 250.5 (122-836) days after LAMS removal without recurrent strictures.
Conclusion: Our single center retrospective cohort study demonstrates safety and efficacy of FCMS in management of post colorectal surgery anastomosis complications. Future large scale prospective studies are required to validate our study findings and assess FCMS as first line therapy in management of post-surgical anastomotic leaks and strictures.
Table 1: Baseline characteristics of stents used for post-surgical anastomotic colorectal strictures
Table 2: Outcomes after placement of fully covered metal stents for post-surgical anastomotic complications
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