Sa1607 A Novel Method for Enteral Stent Placement - Retrograde Endoscopic Guidance

Abstract

generally performed in the anastomotic stricture of the lower rectum with a high frequency of restenosis. Although it has been reported that radial incision and cutting (RIC) using electrosurgical insulated tip (IT) knife is effective for refractory anastomotic stricture after esophagectomy, little is known regarding RIC for anastomotic stricture after ISR or LSR. Aim: To evaluate retrospectively the efficacy and safety of RIC for anastomotic stricture in the lower rectum after ISR or LAR. Methods: Between December 2008 and November 2011, a total of 405 patients underwent ISR or LAR in our hospital and the patients who were treated by RIC for severe anastomotic severe stricture were enrolled. We assessed the patients’ characteristics, clinical course and complications. The indications for RIC were followed: 1) the endoscope (GIF Q260, Olympus) could not pass through the stricture before colostomy closure, 2) the patients had difficulty in defecation such as constipation and abdominal distension after colostomy closure. Results: Of 405 patients, 38 (9.4%) had postoperative anastomotic stricture and 7 (1.7%) with severe stricture received dilatation by RIC. The male to female ratio was 6 to 1, with median age of 66 years ranging from 56 to 72. ISR and LAR were performed in 4 and 3 patients, respectively, and all patients received a temporary colostomy. Before RIC, stricture diameter less than 2mm, 3 to 5mm, and 6 to 10mm were found 4, 1, and 2 patients, respectively. A total of 16 sessions of RIC was performed. Of 16 sessions, 14 sessions were performed in hospitalization with the median length of 3 days (range, 2 5), while 2 sessions were performed as an outpatient. The median procedure time of RIC was 18 minutes (range, 7 34), and no complications such as penetration, bleeding, and high fever were observed. The median follow-up time after the RIC procedure was 27 months (range, 18 55). During follow-up periods, restenois occurred to 2 patients and more than 4 times RIC was required. However, 5 patients did not suffer restenosis and improve the defecation. Conclusions: Dilatation by RIC was feasible, effect and safe for severe anastomotic stenosis in the lower rectum after ISR or LAR. RIC can be a novel method in patients with refractory anastomotic stricture for existing dilatation such as balloon or bougie.