"Cut and Cover": A Case Series of Dual Modality Treatment With Stricturetomy and Stenting for Inflammatory Bowel...

Strictures are common in inflammatory bowel disease (IBD) and are managed medically and endoscopically, if feasible, due to the risk of surgical complications. While endoscopic balloon dilation (EBD) is often successful, the need for repeat dilation and subsequent surgery is common. Endoscopic stricturotomy (ESt) has gained popularity but has been limited by frequent post-procedural bleeding. We hypothesized that lumen-apposing metal stent (LAMS) placement ("cover") after ESt ("cut") could prevent bleeding and re-stenosis, and we tested the feasibility of this "cut and cover" technique. This retrospective study includes five patients (mean age 49 years) at Michigan Medicine who underwent ESt followed by LAMS placement for Crohn's-related strictures over a one-year period. Strictures were short (<2 cm) and included anastomotic strictures. All patients had a stent in place for at least one month (median 54 days), with average endoscopic follow-up completed 170 days post-ESt to assess stricture traversability. Immediate technical success was achieved in all cases, with no procedural complications such as bleeding or perforation, although stent migration was noted in 60% of cases by endoscopic follow-up, and one patient was briefly hospitalized for post-procedure abdominal pain. In all four patients who returned for long-term patency reassessment (mean 5.6 months post-ESt), their strictures remained endoscopically traversable. In our small cohort, we found that ESt followed by LAMS placement was technically feasible and demonstrated potential for high rates of clinical and technical success with few complications. Further multicenter studies are needed to confirm the technique's efficacy and safety.