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World J Gastrointest Endosc. Feb 16, 2020; 12(2): 60-71
Published online Feb 16, 2020. doi: 10.4253/wjge.v12.i2.60
Feasibility and safety of self-expandable metal stent in nonmalignant disease of the lower gastrointestinal tract
Ludovica Venezia, Andrea Michielan, Giovanna Condino, Emanuele Sinagra, Elisa Stasi, Marianna Galeazzi, Carlo Fabbri, Andrea Anderloni
Ludovica Venezia, Gastroenterology Unit, AOU Città della Salute e della Scienza Turin, Turin 10100, Italy
Andrea Michielan, Gastroenterology and Digestive Endoscopy Unit, Ospedale Santa Chiara, Trento 38122, Italy
Giovanna Condino, Gastroenterology Unit, Azienda Ospedaliera S.S. Antonio e Biagio e Cesare Arrigo, Alessandria 15121, Italy
Emanuele Sinagra, Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, Cefalù 90015, Italy
Emanuele Sinagra, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo 90100, Italy
Elisa Stasi, Gastroenterology Unit, Department of Medicine, “Vito Fazzi” Hospital, Lecce 73100, Italy
Marianna Galeazzi, University of Milano-Bicocca, School of Medicine and Surgery, Monza 20052, Italy
Carlo Fabbri, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, Azienda U.S.L. Romagna, Ospedale G. Morgagni-L. Pierantoni, Cesena 200868, Italy
Andrea Anderloni, Digestive Endoscopy Unit, Humanitas Research Hospital, Milan 20100, Italy
Author contributions: Sinagra E designed the study; Venezia L, Michielan A, Condino G, and Sinagra E wrote the paper; Fabbri C contributed by performing a revision as an expert in the field; Anderloni A, Stasi E, and Venezia L revised the manuscript; Anderloni A supervised the work; and Galezzi M revised and corrected the English version.
Conflict-of-interest statement: All authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, thus disclosing any conflict of interest regarding such work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emanuele Sinagra, PhD, Doctor, Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, Cefalù 90015, Italy. emanuelesinagra83@googlemail.com
Received: June 10, 2019
Peer-review started: June 12, 2019
First decision: August 2, 2019
Revised: December 8, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: February 16, 2020
Processing time: 211 Days and 11.9 Hours
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 strictures), stenting seems to have a limited evidence-based benefit as a bridge to surgery, while in other settings (such as endometriosis, IBD, radiation colitis, etc.), even society guidelines are not able to guide the endoscopist through decisional algorithms for SEMS placement. The aim of this narrative paper is to review the scientific evidence regarding the use of SEMSs in nonmalignant diseases of the lower gastrointestinal tract, both in adult and pediatric settings.

Keywords: Self-expandable metal stents; Lower gastrointestinal tract; Benign strictures

Core tip: Even though it may be technically feasible to proceed to stenting in nonmalignant diseases of the lower gastrointestinal tract, the outcome has been reported to be poor. In fact, in some settings, stenting seems to have a limited evidence-based benefit as a bridge to surgery, while in other settings, even society guidelines are not able to guide the endoscopist through decisional algorithms for self-expandable metal stent placement. Further studies are required to determine long-term efficacy and safety, while improvements in stent design could help to overcome the risk of adverse events, such as stent migration and perforations.