Stents in the management of benign colorectal strictures

Benign colorectal strictures (BCRS) represent a challenging clinical scenario and are difficult to manage. They mostly originate from postoperative anastomotic strictures, diverticular disease, or Crohn's disease. Surgery has traditionally been the mainstay of treatment but is associated with high complication rates and morbidity. Nonsurgical strategies for managing BCRS include endoscopic dilation, incision with electrocautery, microwave coagulation therapy, laser therapy, and local steroid injection. These modalities are often associated with high complication and recurrence rates. Stent therapy is an alternative nonsurgical option. It has demonstrated good results in the setting of malignancy, both as bridge to surgery and as palliative treatment. Stents have been used in the benign setting with the same indications. However, evidence in this regard is very scarce and inconclusive, and therefore this option is still controversial. There is still uncertainty in indications to stent in BCRS, as well as in timing of both stent placement and removal. The most commonly employed stents have been self-expanding metal stents; experience with plastic and biodegradable stents is less common. The overall efficacy for relief of obstruction in the benign setting seems to be lower than in the setting of malignancy. It seems to be effective in the short and medium terms, but stricture recurrence is quite common, occurring in nearly half of the patients. The few available data with biodegradable stents suggest that they may become an important treatment option in the future. Stenting in the benign setting has been associated with significant morbidity and complications, more so than in the malignant setting. Uncovered stents for example are currently contraindicated for the treatment of BCRS, unless they are used as bridge to surgery. Stenosis arising from inflammation, such as observed in acute diverticulitis and Crohn's disease, as well as radiation-induced strictures may be more prone to complications, thus more caution is recommended while considering stenting in this setting. Future studies should be aimed at defining the best subpopulation of patients that would benefit from stent placement, and new stents should be designed to increase long-term patency rates and reduce complications. In this article, we review the state of art of stenting in the benign setting and point toward future avenues in the management of this challenging clinical scenario. (C) 2014 Published by Elsevier Inc.