Endoscopy 2022; 54(05): E197-E198
DOI: 10.1055/a-1463-2333
E-Videos

Rescue lumen-apposing metal stent to treat a perforation secondary to balloon dilation of a Crohn’s disease stenosis

Raphael Olivier
1   Poitiers University Hospital Center, Hepato-Gastroenterology Department, Poitiers, France
,
Stéphane Scheer
1   Poitiers University Hospital Center, Hepato-Gastroenterology Department, Poitiers, France
,
Jérémie Albouys
2   Limoges University Hospital Center, Hepato-Gastroenterology Department, Limoges, France
,
Marion Schaefer
3   Nancy University Hospital Center, Hepato-Gastroenterology Department, Nancy, France
,
Abdelkader Taibi
2   Limoges University Hospital Center, Hepato-Gastroenterology Department, Limoges, France
,
Sophie Geyl
2   Limoges University Hospital Center, Hepato-Gastroenterology Department, Limoges, France
,
Jérémie Jacques
2   Limoges University Hospital Center, Hepato-Gastroenterology Department, Limoges, France
› Author Affiliations
 

    A 61-year-old woman was followed for ileocolic Crohnʼs disease (CD) with multi-complicated colonic and ano-perineal involvement, evolving over 17 years, with a subtotal colectomy protected by an upstream lateral ileostomy. Optimized adalimumab allowed control of the disease with healing of fistulas.

    However, a scarring colonic stenosis ([Fig. 1]) persisted 30 cm from the anal margin; it could not be crossed by an endoscope and prevented restoration of continuity. Hydrostatic endoscopic dilatation ([Fig. 2], [Video 1]) up to 15 mm was performed after multidisciplinary discussion. After dilation, visualization of pericolic fat confirmed digestive perforation ([Fig. 3]). The proximity between the perforation and the ileocolic anastomosis did not allow the option of a covered metallic stent. A 15-mm lumen apposing metal stent (LAMS) was used ([Fig. 4]). The colonoscope was removed and a therapeutic gastroscope was substituted because of the excessive length of the working channel of the colonoscope (140 cm). Release of the two flanges was performed under endoscopic guidance, and good positioning was confirmed by opacification without any leakage.

    Zoom Image
    Fig. 1 Colonic stenosis located 30 cm from the anal margin.
    Zoom Image
    Fig. 2 Hydrostatic dilatation was performed up to 15 mm.

    Video 1 Rescue lumen-apposing metal stent to treat a perforation secondary to balloon dilation of a Crohn’s disease stenosis.


    Quality:
    Zoom Image
    Fig. 3 Visualization of pericolic fat confirmed perforation.
    Zoom Image
    Fig. 4 Positioning of a 15-mm lumen-apposing metal stent.

    The post-procedure care was easy, with only 5 days of oral antibiotics and return home on the first day. The LAMS was removed 1 month later with perfect healing of both the perforation and the stenosis ( [Fig.5]). The patient presents stool by the anus for the first time in 4 years, and removal of the ileostomy is being discussed. In cases of perforation during dilation of short fibrous stenosis, off-label use of LAMS through a therapeutic gastroscope seems to be a promising rescue solution.

    Zoom Image
    Fig. 5 Good healing was confirmed 1 month later.

    Endoscopy_UCTN_Code_CPL_1AJ_2AF

    Endoscopy E-Videos
    https://eref.thieme.de/e-videos

    Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.

    This section has its own submission
    website at
    https://mc.manuscriptcentral.com/e-videos


    #

    Competing interests

    The authors declare that they have no conflict of interest.


    Corresponding author

    Raphael Olivier, MD
    Hepato-Gastroenterology Department
    Poitiers University Hospital Center
    2 Rue de la Milétrie
    86000 Poitiers
    France   
    Fax: +33-5-49-44-38-35   

    Publication History

    Publication Date:
    12 May 2021 (online)

    © 2021. Thieme. All rights reserved.

    Georg Thieme Verlag KG
    Rüdigerstraße 14, 70469 Stuttgart, Germany


    Zoom Image
    Fig. 1 Colonic stenosis located 30 cm from the anal margin.
    Zoom Image
    Fig. 2 Hydrostatic dilatation was performed up to 15 mm.
    Zoom Image
    Fig. 3 Visualization of pericolic fat confirmed perforation.
    Zoom Image
    Fig. 4 Positioning of a 15-mm lumen-apposing metal stent.
    Zoom Image
    Fig. 5 Good healing was confirmed 1 month later.