Position Statement. Recommendations of the Spanish Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the treatment of strictures in Crohn's disease. / Documento de posicionamiento. Recomendaciones del grupo español de trabajo en enfermedad de Crohn y colitis ulcerosa (GETECCU) sobre el tratamiento de la estenosis en la enfermedad de Crohn.

Despite pharmacological advances, strictures in Crohn's disease (CD) continues to be an important problem that leads in a high percentage of patients to undergo endoscopic and/or surgical treatments. There are currently no clinical scores or diagnostic tools that allow predicting which patients will develop this complication, and when a stricture is diagnosed, it is usually already well established and clinically relevant. The current role of pharmacological treatment is limited to treat inflammation and once there is significant fibrosis, the only therapeutic options are endoscopic and/or surgical. To establish a correct therapeutic algorithm and based on the current scientific evidence available, the Spanish Group Working on Crohn's Disease and Ulcerative Colitis (GETECCU) has decided to conduct this position statement on the treatment of strictures in CD. This document embraces the three mentioned therapeutic approaches, medical, endoscopic and surgical. Recommendations and therapeutic algorithms are established to help us to choose the most appropriate option based on the characteristics of the stricture and the patient.

Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks.

BACKGROUND: Endoscopic stents are successful in the management of surgical leaks; however, stent migration remains a significant problem. In this study, we present our approach depending on a large bariatrics-specific stent (Mega stent) and over-the-scope clips in the management of post-bariatric surgery leaks. METHODS: A retrospective analysis of all patients with post-bariatric surgery leaks treated at our institution using an approach reliant on Mega stents and over-the-scope clips was conducted. Potential factors associated with procedure success and occurrence of complications were also evaluated. RESULTS: A total of 81 stents were inserted in 62 patients with post-bariatric surgery leaks, 46 sleeve gastrectomies (73%) and 16 Roux-en-Y gastric bypass (27%). Over-the-scope clips were applied in 29 patients (46%). Leak closure was achieved in 51 patients (82%). Median number of procedures per patient was 3 (range 2-8). Complications included the following: stent migration (11/62, 18%), intolerance necessitating premature removal (7/62, 11%), esophageal stricture (8/62, 13%), bleeding (4/62, 6%), perforation (4/62, 6%). One stent-induced mortality was encountered (bleeding). The presence of open surgery (vs laparoscopic) was significantly associated with the occurrence of stent-induced complications (p 0.002). CONCLUSION: The approach combining Mega stents and over-the-scope clips is highly effective in the management of post-bariatric surgery leaks and is associated with a low rate of stent migration and a low number of procedures and stents per patient. Mega stents, however, should be used with great caution due to the significant morbidity associated with their use.

Update on Enteral Stents.

OPINION STATEMENT: The recent advances in enteral stents design and composition introduced novel usage and indications, heading to a continuous addition of prostheses application in clinical practice. Since the first use to palliate malignant diseases, improving patient's quality of life, in the last decades we assisted to a large spread, often becoming a first choice treatment in GI disorders. Indeed, the clinical indication of gastrointestinal stents includes endoscopic treatment of fistula and leaks besides the well-established role of restoring lumen patency in benign and malignant conditions. Several different kind of stents have been developed, each one with its own characteristics and benefits, including self-expandable plastic and metal stents, available as uncovered, partially covered, and fully covered as well as biodegradable stents. Recently, new drug-eluting stents, working both as palliative treatment and as local chemotherapy, are under evaluation. This review aims to critically evaluate the most recently published literature about enteral stents and to address endoscopists' choice for a better patient management.