Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results.

Abstract

Endoscopic dilation has proven to be a valid therapeutic alternative to surgery for treating postoperative anastomotic colonic strictures. The authors here evaluate retrospectively the short and long-term clinical results obtained in such patients by pneumatic dilation. From March 1986 to December 1993, 18 patients who had undergone surgery for colorectal cancer were treated for a postoperative symptomatic stricture. Four patients had undergone a left hemicolectomy and 14 an anterior resection. The strictures had a diameter of less than 2 mm, and a length ranging from 5 to 29 mm. The dilations were performed using a 30-40 mm pneumatic dilator for achalasia. The clinical results were classified in relation to the abdominal symptomatology reported by the patients, and were evaluated in the short term (one week) and long term (mean follow-up: 39 months). Seventeen of the 18 patients underwent a total of 45 dilating sessions; one patient was excluded because a recurrence was diagnosed at the suture line. Five patients had a single dilating session; eight patients had two sessions, and four patients had a mean of 4.5 sessions. Two complications were observed: a punctiform bowel perforation and one transient mucosal bleeding. Immediate symptomatic relief was achieved in all cases, and good long-term clinical results were achieved in 16 patients (94.1%). Endoscopic dilation with an achalasia balloon has proved to be safe and simple to perform, and allowed us to obtain good short-term and long-term clinical results. This type of dilation may be considered the first-line therapeutic approach for symptomatic benign colonic anastomotic strictures.