Feasibility and safety of self-expandable metal stent in nonmalignant disease of the lower gastrointestinal tract

Venezia L, Ludovica Venezia, Michielan A, Andrea Michielan, Giovanna Condino, Condino G, G. Condino, Sinagra E, Emanuele Sinagra, Elisa Stasi, Stasi E, Galeazzi M, Marianna Galeazzi, Fabbri C, Carlo Fabbri, Anderloni A, Andrea Anderloni
World journal of gastrointestinal endoscopy · 2020 · vol. 12(2) , pp. 60–71 · doi:10.4253/wjge.v12.i2.60 · PMID:32064031 · PMC6965004 · W2999669099
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This study investigated the feasibility and safety of self-expandable metal stents for nonmalignant conditions of the lower gastrointestinal tract, finding poor outcomes in many cases.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This narrative review examined the feasibility and safety of self-expandable metal stents (SEMSs) for nonmalignant lower gastrointestinal strictures and related complications across adult and pediatric settings, synthesizing evidence from studies in conditions such as diverticulitis, postoperative anastomotic strictures, anastomotic leakage/fistulas, and colovaginal fistulas. Across diverticulitis-related obstruction reports, technically successful placements were common, but complications—especially perforation (including a series with 11 perforations out of 66 placements) and occasional migration—were frequent, and the paper explicitly notes controversies and limited support except for patients unfit for surgery or when surgery occurs within about 1 month. For postoperative anastomotic complications, systematic review data suggested relatively higher healing success for anastomotic leakage/fistulas (around 75%), while success for postoperative strictures was more variable (about 50% for long-term success) and sometimes constrained by stent design leading to early migration. Relevance to endometriosis: the paper explicitly mentions endometriosis as an additional indication for SEMS use in the lower gastrointestinal tract, though the rest of the evidence primarily focuses on diverticulitis and postoperative complications.

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Abstract

In recent years, self-expandable metal stents (SEMSs) have been employed to treat benign gastrointestinal strictures secondary to several conditions: Acute diverticulitis, radiation colitis, inflammatory bowel disease (IBD), and postanastomotic leakages and stenosis. Other applications include endometriosis and fistulas of the lower gastrointestinal tract. Although it may be technically feasible to proceed to stenting in the aforementioned benign diseases of the lower gastrointestinal tract, the outcome has been reported to be poor. In fact, in some settings (such as complicated diverticulitis and postsurgical anastomotic WJGE https://www.wjgnet.com
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Sems

Evidence regarding the use of endoscopic stents for colonic strictures in children is very scarce. Furthermore, there are no commercially available colonic stents for pediatric patients, and therefore, stents approved for other gastrointestinal districts have been used, according to the child’s age[ 61 ]. Both plastic self-expandable stents and SEMSs (2 cases) have been used for AS following surgery for Hirschsprung’s disease or total colonic aganglionosis (Zuelzer-Wilson syndrome)[ 61 , 62 ]. Stent migration was frequent and required repeated stent placement. Moreover, tenesmus was a common complaint since the stents were located in close proximity to the dentate line due to the sensitive mucosa of the anal verge. No guidelines exist for SEMS placement in pediatric patients.

Conclusion

The present review aimed to assess the evidence regarding the use and expected benefits of SEMSs in nonmalignant diseases of the lower gastrointestinal tract. Literature concerning this approach is missing, and robust data from randomized trials or large prospective studies are still lacking. Because of such scarceness of data, the available international guidelines for specific settings (such as endometriosis, IBD, radiation colitis) do not consider the use of SEMSs and are not able to guide the endoscopist with a decisional algorithm for SEMS placement. Although it may be technically feasible to proceed to stenting, the use of SEMSs is usually indicated after the failure of other endoscopic or nonendoscopic treatments and in carefully selected patients (such as patients unfit for surgery). Nevertheless, the use of SEMSs has been investigated and seems promising in specific settings, such as CD-related strictures, AF, AL, and endometriosis. In other settings, including AF, AL, and ischemic and radiation colitis, the number of patients enrolled in published studies is too low to draw firm conclusions. In CD strictures, data arising from the literature show that endoscopic stenting should be considered in patients with stenosis not suitable for EBD (strictures longer than 4 cm or complex and fibrotic strictures, rather than mixed fibrotic/edematous strictures) and could prevent or delay the need for surgical resection in surgical candidates. In AF and AL after colorectal surgery, the use of fully-covered SEMS leads to healing and resolution without the need for subsequent surgery in approximately 75% of patients. Requirements for a successful procedure included previous drainage of perirectal abscesses, absence of systemic infection ( i.e. , sepsis) and localization of the lesions > 1 cm above the dentate line[ 13 ]. The use of SEMSs has been evaluated in endometriosis stenosis, a rare manifestation of the disease that usually requires emergency surgery and that is associated with high rates of mortality and stoma creation. As demonstrated by several case reports, the stenting of the stricture provides a safe bridge to elective and definitive surgery, avoiding stoma creation and its inevitable subsequent psychological drawbacks, even if a laparoscopic approach (with the ablation of endometriosic nodules) and hormonal therapy are actually the standard of care in this setting. In AS, the placement of SEMSs leads to clinical success in approximately half of patients and seems to be a reasonable choice for refractory AS. In this field, the use of BD stents is promising, as confirmed by preliminary results in the literature[ 14 , 16 ]. A greater amount of data is available regarding the role of SEMSs in acute diverticulitis. The high rate of complications associated with bowel inflammation (migration, perforation) generally contraindicates stenting, and this is also supported by the ESGE guidelines[ 3 ]. However, among patients unfit for surgery[ 9 ] or undergoing surgery within 1 mo[ 10 ], placement of a stent could represent exceptions and possible indications in the presence of a fibrotic stricture. In conclusion, stenting may play a role in the palliative management of benign colorectal strictures in selected cases, both as a palliative measure and a bridge to surgery, but it should be preceded by careful patient counseling regarding the expected benefits, as well as the possible adverse events. Because of the limited evidence available, SEMS placement in the context of benign disease should currently be considered “off-label” and should be considered as an alternative treatment after multidisciplinary evaluation and, when possible, in the setting of clinical trials. Evidence of the long-term efficacy and safety of such interventions requires further study. Improvement in stent design, to overcome the risk of adverse events, such as stent migration and bowel perforation, is mandatory. In the near future, the evolution of materials and devices, as well as the creation of a database specifically targeting colonic pathology, may bring about changes to what is stated in this review.

Introduction

Placement of self-expandable metal stents (SEMSs) represents a minimally invasive option to achieve colonic decompression in stenosing colorectal cancer (CRC)[ 1 ]. In fact, SEMSs are currently used for obstructions due to CRC in the setting of palliative care[ 2 , 3 ], while their use as a bridge to surgery is still a matter of debate. To date, colonic stenting for potentially treatable conditions is only suggested for high-surgical-risk patients with left-sided obstruction[ 3 ]. Nevertheless, some studies suggest that SEMS placement could prevent proximal synchronous lesions after colonic decompression prior to curative surgery[ 2 - 6 ]. The growing experience in the management of malignant acute colonic obstruction with SEMSs indicates a reduction in morbidity and mortality, as well as in costs, compared to the effects of surgical treatment[ 4 ]. Recently, SEMSs have been employed to treat benign gastrointestinal strictures secondary to several conditions: Acute diverticulitis, radiation colitis, inflammatory bowel disease (IBD), and postanastomotic leakages and stenosis[ 7 ]. Other applications include endometriosis and fistulas of the lower gastrointestinal tract[ 7 ]. However, the use of SEMS in nonmalignant gastrointestinal tract diseases is still controversial with regard to safety and efficacy[ 7 ]. The aim of this narrative paper is to review the scientific evidence concerning the use of SEMSs in nonmalignant diseases of the lower gastrointestinal tract, both in adult and pediatric settings.

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