Hépato-Gastro-Entérologie MICI Assistance Nutritive, Hôpital Beaujon, Clichy-La-Garenne, France.
Hépato-Gastro-Entérologie, Hôpital Huriez, Lille, France.
J Crohns Colitis. 2021 Apr 6;15(4):521-528. doi: 10.1093/ecco-jcc/jjaa208.
In Crohn's disease, strictures are frequent and may require surgical resection or endoscopic balloon dilation. An anti-migration, removable and shaped self-expandable metal stent is available. We evaluated its effectiveness and safety in a real-life setting.
All centres were asked to collect retrospectively or prospectively all data on patients who had a stent for a stricture. The anti-migration stent [Hanarostent HRC-20-080-230-MITech, Seoul, South Korea] was maintained 7 days before its extraction during a second colonoscopy. Short- and long-term efficacy and safety outcomes were evaluated.
A total of 46 patients were enrolled. Strictures were anastomotic in 73.9% of cases. The median length of the stricture evaluated by cross-sectional imaging and during colonoscopy was 3.1 ± 1.7 and 2.7 ± 1.4 cm, respectively. Immediate success [no obstructive symptom at Day 30] was reported in 93.5% of cases (95% confidence interval [CI] = [86.3; 99.9]). Sixteen patients needed a new balloon dilation [n = 8] or surgery [n = 8]. The overall success rate [obstruction-free without any intervention] was 58.7% [n = 27] after a median follow-up of 26 months [8-41 months]. No perforation occurred and three migrations were observed [6.5%]. Perianal disease (hazard ratio [HR] = 0.1 [0.02; 0.58]) and discontinuation of an immunosuppressant (0.12 [0.02; 0.86]), were associated with a lower probability of success, whereas performing imaging (HR = 5.3 [1.2; 23.5]) before stent placement was associated with success.
The anti-migration stent is safe and effective in about half of patients, with no perforation reported in this study, and has an extremely low migration rate.
在克罗恩病中，狭窄很常见，可能需要手术切除或内镜球囊扩张。有一种抗迁移、可移除和成型的自膨式金属支架可供选择。我们在真实环境中评估了其疗效和安全性。
所有中心均被要求回顾性或前瞻性收集所有接受支架治疗狭窄患者的数据。抗迁移支架[Hanarostent HRC-20-080-230-MITech，韩国首尔]在第二次结肠镜检查时保留 7 天，然后取出。评估短期和长期疗效和安全性结果。
共纳入 46 例患者。狭窄位于吻合口的占 73.9%。横断面成像和结肠镜检查评估的狭窄长度中位数分别为 3.1 ± 1.7 cm 和 2.7 ± 1.4 cm。93.5%（95%置信区间[CI] = [86.3; 99.9]）的患者报告了即刻成功[30 天无梗阻症状]。16 例患者需要新的球囊扩张[8 例]或手术[8 例]。中位随访 26 个月[8-41 个月]后，无干预的无梗阻总体成功率为 58.7%[27 例]。未发生穿孔，观察到 3 例迁移[6.5%]。肛周疾病（风险比[HR] = 0.1 [0.02; 0.58]）和免疫抑制剂停药（0.12 [0.02; 0.86]）与成功率降低相关，而支架放置前进行影像学检查（HR = 5.3 [1.2; 23.5]）与成功率相关。
在本研究中，未报告穿孔，抗迁移支架在约一半的患者中是安全有效的，且迁移率极低。
