Fluoroscopic self-expandable metallic stent placement for treating post-operative nonanastomotic strictures in the proximal small bowel: a 15-year single institution experience.

Objective: To evaluate the efficacy and safety of fluoroscopic self-expandable metallic stent (SEMS) placement for treating postoperative nonanastomotic strictures in the proximal small bowel.

Methods: Data from 8 consecutive patients (mean age, 63.8 ± 6.9 years; 7 males and 1 female) who underwent 17 fluoroscopic SEMS placement procedures in total for treating postoperative nonanastomotic strictures in the proximal jejunum were retrospectively reviewed. The most recent surgery for all the patients was total gastrectomy with esophagojejunostomy. Strictures were located in the proximal jejunum in all patients. The mean length of the strictures was 5.8 ± 2.0 cm. Five patients with comorbidities were poor surgical candidates. Four patients underwent fluoroscopic balloon dilation, three of whom showed no resolution of obstructive symptoms and one demonstrated recurrence of symptoms.

Results: Technical and clinical success was achieved in 100% (17/17) SEMS procedures. Complete resolution of obstructive symptoms and improvement in oral intake status occurred within 3 days after all procedures, rendering a clinical success rate of 100% (17/17). No complication occurred during or after the procedures. The median follow-up duration was 167 [interquartile range (IQR), 48-576] days. Stent malfunction occurred after 58.8% (10/17) of the procedures, including six occurrences of stent migration and four of benign tissue hyperplasia. Surgical removal of the migrated stents was performed in two patients. Recurrence of symptoms occurred after 64.7% (11/17) of the procedures. The median stent dwell and recurrence-free times were 32 (IQR, 20-193) and 68 (IQR, 38-513) days, respectively.

Conclusion: Fluoroscopic SEMS placement may be effective and safe for treating postoperative nonanastomotic strictures, but stent malfunction and recurrence are major drawbacks.

Advances In Knowledge: SEMS placement is effective and relatively safe in patients with postoperative nonanastomotic strictures in the proximal small bowel. Patients section and counseling is highly encouraged.