Benign Colorectal Stricture: An Answer to the Balloon or Stent Question?

Benign colorectal strictures have numerous causes, including postoperative stenosis, radiation, diverticular disease, ischemia, and inflammatory bowel disease. Although surgical management was once considered the standard treatment for benign colorectal strictures, advances in endoscopic techniques and various accessories have enabled successful treatment of benign colorectal strictures using endoscopic procedures such as balloon/bougie dilation and stent implantation. Still, a consensus regarding the adequate endoscopic management of benign colorectal strictures has not yet been reached. In this issue of Gut and Liver, Park et al. report their retrospective analysis comparing balloon dilatation and self-expanding metal stents (SEMS) in patients with benign colorectal stricture. The authors provide objective data, including short-term clinical efficacy (technical success, clinical success, reobstruction, and procedural failure), complications, and stent patency. They also offer information on predictive factors for clinical success and risk factors for procedural failure. The use of SEMS for colorectal stricture has grown over time. Their indications have expanded from the management of acute malignant colorectal obstruction to the treatment of benign colorectal strictures. According to current literature, considerable variation in efficacy of SEMS for the treatment of benign colorectal strictures has existed. Disappointingly, Park et al. show that, though the rates of initial clinical success and reobstruction were similar, the duration of patency was shorter for the SEMS group than the balloon dilatation group (2.0±0.6 months vs 65.5±13.3 months). However, it could be argued that the longer patency of the balloon dilatation group could be due to uncontrolled confounding by indication, that is, that SEMS use reflects more severe stricture. The authors found no signifi-