Hillary Smalley, DO1, Rohit Khanna, DO2, Matthew Skinner, MD2, Keith Beiermeister, MD3, Lynn Weston, MD3, Melissa Ferrari, PA-C, MPAS3, Mazer Ally, MD4, Gauree Konijeti, MD, MPH, FACG3 1Naval Medical Center San Diego, San Diego, CA; 2Scripps Green Hospital, La Jolla, CA; 3Scripps Clinic Medical Group, La Jolla, CA; 4Scripps Clinic Medical Group, San Diego, CA Introduction: Strictures in Crohn's disease (CD), affecting native bowel and surgical anastomoses, particularly ileocolonic anastomoses (ICA). Endoscopic balloon dilation is often effective, though limitations include stricture length, angulation, and ulceration. Partially covered metal stents might effectively treat short CD strictures, but they require removal after one week. Not only is there a risk for stent migration or impaction, but their long-term durability is unclear. Here we present the use of an Axios fully covered lumen apposing metal stent (LAMS) for a symptomatic ICA stricture in a patient with CD.
Case Description/
Methods: A 76-year-old male withpenetrating/stricturing ileocolonic CD since 1978 presented with a small bowel obstruction (SBO). Initially managed with mesalamine and steroids, he developed an ileosigmoid fistula and pelvic abscess in 1982 requiring ileocecectomy with side-to-side ICA, partial small bowel resection (3-4 feet), and partial sigmoidectomy. His quiescent disease required periodic ICA dilations until 2016, when he underwent laparoscopic resection of the ICA stricture. He remained off IBD therapy until 2023, when a SBO recurred due to ICA stricture. In 2024, colonoscopy revealed a pinhole opening balloon dilated to 11 mm, later identified as a blind ileal limb. An adjacent pinhole, confirmed as the ICA, could not be dilated due to angulation and ulceration. Under fluoroscopic guidance, there was successful placement of a LAMS across the ICA stricture with overall clinical improvement. After three months, the stent was removed, the ICA was dilated to 12mm with mild terminal ileal erythema and erosions, with inactive ileitis on biopsy. Advanced therapy was offered; monitoring was chosen. Follow-up intestinal ultrasound was normal and fecal calprotectin was 90 µg/g. One year post-stent removal, colonoscopy showed a superficially ulcerated Rutgeerts i2a ICA stricture, successfully dilated to 15 mm with improved patency and a normal neo-terminal ileum. Discussion: Our application of a LAMS for chronic anastomotic stricture represents a novel approach, with limited number of similar cases in the literature. This is a promising alternative to surgery for older patients or those with complex histories. The Axios was selected due to its sustained radial force against fibrotic tissue and dumbbell shape, which prevents migration and supports luminal patency. Though typically temporary we utilized the Axios LAMS to avoid additional complex SBOs.
Figure: A. Ileocolonic Anastomotic Stricture B. Lumen Apposing Metal Stent Placement C. Balloon Dilation of Stricture (One Year Later) D. Post Dilation
Disclosures: Hillary Smalley indicated no relevant financial relationships. Rohit Khanna indicated no relevant financial relationships. Matthew Skinner: Boston scientific – Consultant. Microtech – Consultant. Keith Beiermeister indicated no relevant financial relationships. Lynn Weston indicated no relevant financial relationships. Melissa Ferrari: Abbvie – Speakers Bureau. Eli Lilly – Advisory Committee/Board Member. Johnson and Johnson – Speakers Bureau. Pfizer – Advisory Committee/Board Member. Mazer Ally: Abbvie – Speakers Bureau. Lilly – Advisory Committee/Board Member. Gauree Konijeti: Abbvie – Advisory Committee/Board Member, Consultant. Johnson and Johnson – Consultant. Lilly – Consultant, Speakers Bureau. Pfizer – Advisory Committee/Board Member. Takeda – Speakers Bureau. WellTheory – Consultant, Stock Options.
Hillary Smalley, DO1, Rohit Khanna, DO2, Matthew Skinner, MD2, Keith Beiermeister, MD3, Lynn Weston, MD3, Melissa Ferrari, PA-C, MPAS3, Mazer Ally, MD4, Gauree Konijeti, MD, MPH, FACG3. P3385 - Novel Use of Lumen Apposing Metal Stents (LAMS) for Complicated Anastomotic Crohn's Strictures, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
