Safety and efficacy of fully-covered self-expandable metal stent placement for refractory stomal stenosis

Stomas, critical in managing various gastrointestinal conditions, can lead to complications like stomal stenosis, affecting 2% to 15% of patients and causing significant morbidity. Traditional treatments such as balloon dilation and surgical revisions often fail to provide lasting relief. This study investigated a novel, minimally invasive approach using fully-covered self-expanding metal stents (FCSEMSs) to address refractory stomal stenosis effectively.

Five patients with recurrent stomal strictures unresponsive to conventional treatments underwent stent placement. Etiologies included Crohn's disease, ischemia, and post-surgical fibrosis. Stents were selected based on stricture characteristics, ranging from 10 to 16 mm in diameter and 6 to 10 cm in length. Technical success was defined as successful deployment without immediate complication; clinical success was defined as sustained symptom resolution during follow-up. Outcome measures included abdominal girth, pain reduction (visual analog scale), vomiting, and dietary tolerance. Follow-up periods ranged from 8 weeks to 6 months.

All procedures were technically successful. Mean abdominal girth decreased from 114 ± 4.2 cm (range 108-119) to 103 ± 3.7 cm (range 99-108). Pain scores decreased from a mean of 8 ± 1.1 to 2 ± 1.2. Vomiting, bloating, and dietary tolerance improved in most patients. No stent migration or erosions/ulcer was observed during follow-up. Four patients had follow-up to 6 months without restenosis. One patient had restenosis with successful re-stenting within a 6-month follow-up period.

FCSEMSs represent a safe and effective minimally invasive alternative for refractory stomal stenosis, with promising short-term outcomes.