Colonic Anastomotic Strictures Research Articles

Endoscopic ultrasound-guided colo-colostomy for the treatment of benign complete occlusion of colonic anastomosis: a case series and description of technique.

The incidence of benign colonic anastomotic stricture is approximately 2% in patients undergoing left hemicolectomy or anterior resection and as high as 16% in patients undergoing low anterior or intersphincteric resection. In the majority, rather than complete occlusion, a stenosis forms, which can be managed with endoscopic balloon dilatation, a self-expanding metallic stent or endoscopic electroincision. In the less common scenario of a completely occluded colonic anastomosis, surgery is often required. In this study, we aim to describe the technique we used to treat this condition non-operatively METHOD: We describe a case series of three patients with benign complete occlusion of their colorectal anastomosis and how we managed them nonoperatively with a colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a Hot lumen-apposing metallic stent. We demonstrate that the technical and clinical success for this technique is 100%. We believe that the technique we describe is effective and safe. It should be widely reproducible in centres with expertise in interventional EUS, given the similarity to well-established procedures such as EUS-guided gastroenterostomy. Patient selection and timing of reversal of ileostomy need careful consideration, especially in patients with a history of keloid formation. Given the shorter hospital stay and reduced invasiveness of this technique, we believe it should be considered for all patients who have complete benign occlusion of a colonic anastomosis. However, given the small number of cases and short period of follow-up, the long-term outcome of this technique is not known. More studies with higher power and a longer period of follow-up should be conducted to further ascertain the effectiveness of this technique.

Endoscopic strictureplasty for severe colonic anastomotic stricture.

Endoscopic strictureplasty for severe colonic anastomotic stricture.

A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty

Aim: Colonic anastomotic strictures are usually caused by staple use, anastomotic leakage, intestinal or suture line ischemia and radiotherapy. Endoscopic treatments should be the first choice. Resection of the stricture line and re-anastomosis form the basis of surgical treatment. Compared to endoscopic approaches, the morbidity rate of surgical treatments for strictures are higher. In patients with stricture and history of multiple pelvic surgeries who don’t allow endoscopic treatments, magnetic compression strictureplasty (MCS) may be a good choice for lower morbidity. Methods: The study population included patients with colorectal anastomotic stricture who had failed endoscopic treatments and for whom a tertiary resection and anastomosis was also considered as having high morbidity. Firstly, the MCS technique was planned by colonoscopic approach. It was aimed to place the magnet proximal to the stenotic colon with the colonoscope, which has a ring-shaped magnet attached at the tip, through the ileostomy entrance. This endoscopic approach failed. Then, laparotomy was performed. A 1-cm colotomy was performed from the proximal site of the stricture, and the magnet was left inside the intestine. Another magnet was placed distally to stricture from the anus. The two magnets were observed to compress the stricture by magnetic attraction, and the operation was terminated. Patient demographics, surgical history, MRI results, colonoscopic examination results were recorded. The follow-up conditions of the patients were noted.Results: MCS was performed on two male patients mean aged 70 (14.14) years. All patients had multiple abdominal surgeries in their surgical history. Colonoscopy showed fully obstructing anastomotic stricture in patients. The mean distance from the anal verge to the stricture in colonoscopic examination was 7±1.41 cm. Mean stricture length in MRI was 12±2.82 mm. In follow up, control rectosigmoidoscopies revealed that the magnets had fallen into the rectum lumen and the stricture line was fully patent for all patients.Conclusion: MCS might be preferred as a safe surgical technique with low morbidity in patients with previous multiple colorectal surgeries and a full obstructive stricture in the colorectal anastomosis line.

Lumen-apposing stent placement for management of a short benign colonic anastomotic stricture.

Lumen-apposing stent placement for management of a short benign colonic anastomotic stricture.

Lumen-apposing covered self-expanding metal stent for management of benign gastrointestinal strictures.

Background and aims: Self-expanding metal stents (SEMS) are safe and effective for endoscopic management of malignant gastrointestinal strictures, but there is limited experience with their use in refractory benign strictures. We assessed the use of a new lumen-apposing covered SEMS for the management of benign gastrointestinal strictures. Methods: A single-center case-series of five patients who underwent lumen-apposing covered SEMS placement for benign gastrointestinal strictures. Results: Three patients had a benign gastroduodenal stricture, one had a distal colonic anastomotic stricture, and one with complete gastrojejunal anastomotic stenosis underwent endoscopic creation of a new gastrojejunostomy. None of the patients developed any immediate or delayed stent-related adverse events. In two patients, the stents were left in place indefinitely. Stents were removed from the other three patients with successful resolution of their symptoms during follow-up. Conclusion: Lumen-apposing, fully covered SEMS appear to be safe and effective for management of selected benign gastrointestinal strictures.

Colonic stent and percutaneous ethanol injection as a treatment for colocutaneous fistula secondary to benign stricture.

We report successful treatment of colocutanteous stulae at the site of a benign colonic anastomotic stricture using Self-Expandable Metal Stents (SEMS) and Percutaneous Ethanol Injection (PEI). The stricture and the secondary stulae developed after Hartmann’s procedure for sigmoid diverticular abscess followed by reversal of the Hartmann’s procedure with a de-functioning loop ileostomy. Although there have been previously reported cases of SEMS for closure of malignant colonic stula, there are limited reports of SEMS for closure of benign colonic stulae and none of SEMS combined with PEI for benign colonic fistula. We conclude that this patient’s case exemplies the potential applications of SEMS combined with PEI as a feasible option of therapy for benign colorectal disease.

Treatment of a completely obstructed colonic anastomotic stricture using a CT-guided endoscopic rendezvous technique

Treatment of a completely obstructed colonic anastomotic stricture using a CT-guided endoscopic rendezvous technique

Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope and facilitated by SpyGlass (with videos)

Colonic anastomotic strictures complicate colorectal resection in up to 7% of cases and are often managed with endoscopic dilation. Complete anastomotic obstructions are rare and have traditionally required surgical remediation. To demonstrate a novel endoscopic approach to treat complete colonic anastomotic obstruction. Case report. Tertiary-referral center. A 40-year-old woman with a completely obstructed colonic anastomosis after sigmoidectomy for a fibrotic Crohn's stricture. A prototype front-view and forward-array echoendoscope was used to recanalize the completely obstructed anastomotic stricture. Real-time EUS imaging guided puncture through the stenosis. Access into the proximal obstructed segment was confirmed by using SpyGlass fiberoptic probe visualization. Subsequent stricture dilation was performed by using wire-guided balloon dilators through the instrument channel of the prototype echoendoscope, and luminal continuity was reestablished. Technique success and complications. The completely obstructed anastomotic stricture was successfully recanalized and dilated by using a single, prototype, forward-array echoendoscope without complications. Single case report with a relatively short follow-up interval. EUS-guided puncture and dilation of completely obstructed anastomotic strictures is feasible when using a prototype forward-array echoendoscope. This novel technique appears to be an effective method to reestablish luminal continuity across completely obstructed strictures.

Endoscopic balloon dilatation of colonic anastomotic strictures.

Nine postoperative colonic and rectal strictures were treated using dilatation balloons passed over a guide-wire introduced endoscopically. Six strictures resolved after a single dilatation. The method is simple, safe, effective and avoids further surgery.

Greater than 3 dilations is an adverse prognostic factor in colonic anastomotic stricture dilation

Greater than 3 dilations is an adverse prognostic factor in colonic anastomotic stricture dilation

Outcome of endoscopic dilation in 34 patients (PTS) with colonic anastomotic strictures (STX)

Outcome of endoscopic dilation in 34 patients (PTS) with colonic anastomotic strictures (STX)

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

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.

Treatment of Colonic Anastomotic Strictures with ‘Through the Scope’ Balloon Dilators

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Treatment of Colonic Anastomotic Strictures with ‘Through the Scope’ Balloon Dilators

Stricture occurs in 1.2-4.2% of colonic anastomoses. Symptomatic strictures have previously been treated by resection and re-anastomosis and more recently by radiographically guided dilatation by a modified Seldinger technique. This paper describes the endoscopic balloon dilatation of five symptomatic cases and three asymptomatic cases. Eight patients underwent balloon dilatation of colonic anastomotic strictures. Four patients had no symptoms post dilatation and the strictures remained patient on follow-up endoscopy. All the remaining patients required re-dilatation at approximately 2 months. One of these patients underwent dilatation but remained symptomatic, the dilatation was repeated and a colonic perforation occurred at this time. Of the other three, two continue to be followed up, and are well and one patient died of disseminated malignancy. Balloon dilatation with 'through the scope' dilators is a simpler technique than radiologically guided dilatation. These early results suggest that endoscopic dilatation may avoid further surgery in some patients with anastomotic stricture.

Endoscopic dilation of colonic postoperative strictures

After the use of surgical staplers had become widespread, the number of colonic postoperative stenoses was observed to have increased. Nevertheless, the clinical relevance of this observation is minimal since only 2-5% of the patients complain of chronic constipation or obstruction symptoms. In such cases medical therapy is somewhat troublesome, and surgical treatment always implies a major operation. Endoscopic dilation has proved to be a reliable, simple, and safe therapeutic alternative. Forty-two patients with evidence of stenosis of either colocolic or colorectal anastomosis underwent mechanical or pneumatic dilation in our unit: 19 patients with a temporary diverting stoma were dilated before the colostomy was removed; in the remaining 23 cases, treatment was given according to the patients' symptoms or because it was not possible to pass the anastomosis with an endoscope. The overall failure rate was 2.4%, and no morbidity or mortality was found. When the percentages of patients successfully treated in one session alone were compared (76.9% versus 51.8%), balloon dilation was found to be more effective than bougienage. In our opinion, endoscopic dilation represents the mainstay of treatment of colonic anastomotic strictures, with surgery being reserved for the rare failures, when recurrence of cancer should be suspected.

A technic for the management of low colonic anastomotic stricture.

A technic for dealing with low-lying anastomotic strictures of the colorectum after operation has been described. It was used successfully in treatment of a single patient and is offered at this time as a possible solution to an otherwise-difficult problem.