Successful endoscopic treatment of a 12-cm small-bowel Crohn stricture with a custom-made biodegradable stent.

A 52-year-old man originally diagnosed with ulcerative colitis presented with an inflamed small-bowel stricture in the ascending limb of an ileoanal J-pouch and was subsequently diagnosed with Crohn disease. The stricture did not respond to medical treatment with either methotrexate or adalimumab, and repeated endoscopic balloon dilation relieved the patient’s obstructive symptomsonly briefly. As surgical revisionwas deemed impossible, removal of the J-pouch was advised, but the patient refused an ileostomy. MRI and fluoroscopy during endoscopy revealed a stenosis that was 12 cm in length (●" Fig.1). A custom-made biodegradable polydioxanonemonofilament 15-cmstent was manufactured with a body diameter of 15mm and a throat diameter of 18mm (SX-ELLA BD biodegradable stent; ELLACS, Hradec Králové, Czech Republic) (●" Fig.2). The delivery system was designed as a pull systemwith distal release. The endoscopic procedure with stent deployment was performed under radiological guidance, and with the patient under general anesthesia. The delivery of the stent was uncomplicated and no adverse events were registered (●" Fig.3a). The patient described instant relief of his obstructive symptoms. At endoscopic follow-up at 3 weeks the patient felt well and the stent was open (●" Fig.3b). After 8 weeks the stent was still in situ, but had started to degrade (●" Fig.3c). Nevertheless, at present (3-month follow-up) the patient remains without obstructive symptoms. Despite improved medical treatment, Crohn disease can cause strictures throughout the gastrointestinal tract. Effective treatments include bowel resection, stricturoplasty, and endoscopic balloon dilation [1,2]. Partly covered stents have also been used, but have to be removed after 1 week to limit impaction [3]. In this case we report the successful treatment of a long Crohn stricture using a custom-made biodegradable stent.