S4937 Novel Use of Lumen Apposing Metal Stents for Complicated Anastomotic Crohn's Strictures

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 1 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 man with penetrating/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 3 months, the stent was removed, the ICA was dilated to 12 mm 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.