Self-expanding metal stents for treatment of anasto- motic complications after colorectal resection Authors A. Lamazza, E. Fiori, E. De Masi, D. Scoglio, A. V. Sterpetti, E. Lezoche Institution Department of Surgery Pietro Valdoni and Department of Surgery Paride Stefanini, University of Rome La Sapienza, Rome, Italy submitted 13. October 2012 accepted after revision 7. February 2013 Bibliography DOI http://dx.doi.org/ 10.1055/s-0032-1326488 Endoscopy 2013; 45: 493–495 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author A. Lamazza, MD Policlinico Umberto I Viale del Policlinico 00167 Rome Italy Fax: +39-6-49972245 antonietta.lamazza@ uniroma1.it antonio.sterpetti@uniroma1.it Case report/series 493 Introduction ! Since the first descriptions of endoscopic colorec- tal stenting [1, 2], the procedure has become com- mon in clinical practice [3, 4]. Anastomotic com- plications after colorectal resection represent a challenging problem. In the past 13 years, 170 pa- tients with colorectal obstruction underwent placement of a self-expanding metal stent (SEMS) in our Endoscopy Section. Among those patients, 16 patients underwent SEMS placement to treat anastomotic stricture after anterior rectal resection. In nine of the patients the stricture was associated with anastomotic fistula. Results from these 16 patients are presented in this case series. Patients and methods ! All patients who underwent placement of SEMS for anastomotic stricture with or without fistula were included in this study. No patient was ex- cluded. During an 8-year period (2005 – 2012), 16 consecutive patients underwent SEMS place- ment for anastomotic stricture after anterior rec- tal resection. The study was approved by the Hos- pital Ethics Committee and all patients were fully informed and gave informed consent for the pro- cedure. Therapeutic strategy in patients with simple anastomotic stricture Seven patients had only a stricture without fistu- la. In four patients, previous balloon dilation had failed. Three patients had previously undergone a diverting proximal stoma procedure to treat an episode of acute obstruction. Patients were ad- mitted to the hospital and the day before the pro- cedure they received a light rectal enema, which was repeated just before the procedure. The stent was placed with the patient under conscious se- dation with benzodiazepine, according to body weight. At 3 months after stent placement, cov- ered stents were removed from patients; uncov- ered stents remained in place. If there was no evi- dence of residual obstruction, the stoma, if pres- ent, was closed. Therapeutic strategy in patients with anastomotic stricture and fistula Nine patients had a fistula associated with the anastomotic stricture. Patients were admitted to the hospital. A diverting proximal stoma was per- formed before insertion of the stent in six pa- tients (ileostomy in five patients and colostomy in one patient); the three other patients did not have a stoma. The stent was placed with the pa- tient under conscious sedation with benzodiaze- pine, according to body weight. A barium control enema 4 months later was performed to check for anastomotic leakage. If no leak was observed the stoma was closed and 2 weeks later the stent was removed endoscopically, unless it had been pre- Lamazza A et al. SEMS for anastomotic complications after colorectal resection … Endoscopy 2013; 45: 493–495 Self-expanding metal stents (SEMS) can be used to treat patients with symptomatic anastomotic complications after colorectal resection. In the present case series, 16 patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of SEMS. Seven patients had a “simple” anastomotic stricture and nine patients had a fistula associat- ed with the stricture. The anastomotic fistula healed without evidence of residual stricture or major fecal incontinence in seven of the nine pa- tients. Overall the anastomotic stricture was re- solved in 10 of the 16 patients. SEMS placement represents a valid adjunctive to treatment in pa- tients with symptomatic anastomotic complica- tions after colorectal resection for cancer. Downloaded by: University of Washington at Seattle. Copyrighted material.