Pearl Princess Uy, MD1, Eula P. Tetangco, MD, MPH2, Heeyah Song1, Michael J. Coles, MD3, Subbaramiah Sridhar, MBBS, MPH, FRCP, FRCPC, FACG4, John Erikson L. Yap, MD2; 1Medical College of Georgia, Augusta, GA; 2Medical College of Georgia at Augusta University, Augusta, GA; 3Augusta University Medical Center, Augusta, GA; 4AUMC, Augusta, GA
Introduction: Benign colon anastomotic strictures can lead to recurrent hospitalizations from bowel obstruction. Most benign gastrointestinal (GI) strictures are managed endoscopically with endoscopic balloon dilation, intralesional steroid injection, incisional therapy, and self-expanding metal stents(SEMS). However, the management of refractory strictures can be quite challenging. We present a case of an elderly male with a sigmoid anastomotic stricture refractory to repeated endoscopic balloon dilations who was successfully treated with Lumen-Apposing Metal Stent (LAMS).
Methods: A 67-year-old African American male with a history of colon adenocarcinoma S/P sigmoidectomy presented to the hospital 2 years following his surgery with increasing abdominal pain, distention, and obstipation. Physical exam was remarkable for abdominal distention, tenderness, and hypoactive bowel sounds. CT abdomen revealed a significantly dilated colon up to 20 cm in maximum diameter proximal to the colonic anastomotic stricture without free air. Flexible sigmoidoscopy confirmed the sigmoid anastomotic stricture with a remnant lumen of 6mm in diameter. Multiple sequential endoscopic balloon dilation bimonthly was performed up to 20mm, however he had 2 more hospitalizations for bowel obstruction from the dilated recurrent anastomotic stricture. Finally, a 20 mm x 10 mm LAMS stent, was successfully deployed through the stricture. Significant symptom and radiologic improvement were seen. The LAMS remained in place for 8 months and he remained asymptomatic to this date following its removal. Discussion: LAMS are indicated for drainage of pancreatic fluid collections. Less than 20 cases have been reported in literature regarding the off-label use of LAMS in the treatment of colonic strictures. It is deployed across the stricture under fluoroscopic or endoscopic guidance, with a 60% clinical response rate including symptom and stricture resolution. Its complications include ulceration at the stent site, migration, and stricture overgrowth. However, its design, with its short length and wide flanges, reduces the risk of stent migration linked with SEMS which exceeds 40%.
This case highlights the use of LAMS as a potential treatment for the management of refractory colonic strictures. Its ease of use, safety profile, and good response rate makes it an excellent treatment option for recurring bowel obstructions associated with refractory benign colonic strictures.
CT abdomen demonstrating a significantly dilated colon (blue arrow) up to 20 cm in maximum diameter proximal to the colonic anastomotic stricture without free air.
Endoscopic image showing the deployment of the Lumen-Apposing Metal Stent (LAMS) through the colon stricture.
Disclosures: Pearl Princess Uy indicated no relevant financial relationships. Eula Tetangco indicated no relevant financial relationships. Heeyah Song indicated no relevant financial relationships. Michael Coles indicated no relevant financial relationships. Subbaramiah Sridhar indicated no relevant financial relationships. John Erikson Yap indicated no relevant financial relationships.