Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis

Abstract

Despite standardized techniques, anastomotic complications after colorectal resection remain a challenging problem. Among those, anastomotic stricture is a debilitating outcome which often requires multiple interventions and which is prone to recur. The present series investigates the long-term results of endoscopic balloon dilation for stenotic colorectal anastomosis. Consecutive patients from a single institution who presented with an anastomotic stenosis after a colorectal resection were identified using a prospective clinical database. Medical records were systematically reviewed to detail patients' outcomes. Over 17years (1988-2015), 2361 consecutive patients underwent a colorectal anastomosis. Of those, 76 patients (3.2%) suffered a symptomatic anastomotic stenosis within a median of 5months (interquartile range (IQR) 2-13) of the index procedure. All stenoses were primarily treated by endoscopic balloon dilation. Median follow-up was 11years (IQR 7-14). In half the patients, one to two attempts at endoscopic balloon dilation definitively relieved the stenosis. Overall, the median number of endoscopic balloon dilation required was 3 (IQR 2-3). Recurrence rates at 1year, 3year, and 5year were 11, 22, and 25%, respectively. Median time to recurrence was 12months (IQR 3-24). Ultimately, two patients (2.6%) underwent an operation due to failure of endoscopic treatment. All other patients (97.4%) were treated successfully with endoscopic balloon dilation. A total of 12 patients (15.7%) suffered a complication from endoscopic dilation. Of those, 11 were minor bleeding and one was a perforation at the level of the anastomosis. All complications were managed conservatively, and no emergency procedure was required as a consequence of attempted endoscopic balloon dilation. Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection.