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

Endoscopic management of severe colo-colonic anastomotic stricture

Video 1A therapeutic approach: endoscopic management of severe colo-colonic anastomotic stricture.

Short benign ileocolonic anastomotic strictures - management with bi-flanged metal stents: Six case reports and review of literature

BACKGROUND

The endoscopic management of benign short post-anastomotic ileocolonic stricture (PAICS) that is refractory to primary and secondary treatment modalities remains challenging. The lumen-apposing metal stent (LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy. LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents (FCSEMSs).

CASE SUMMARY

This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature. We report a life-saving technique not previously documented and the use of technology to improve patient outcomes. The six patients (median age, 75 years) suffered from vomiting, constipation and recurrent abdominal pain, with symptoms starting 23-25 wk post-surgery. The median stricture length was 1.83 cm. All six patients underwent successful and uneventful bi-flanged metal stent (BFMS)-LAMS placement for benign PAICS. All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal. According to the literature, the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding. Conversely, FCSEMS has a high migration rate (15%-50%).

CONCLUSION

The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options, allowing them to avoid more invasive surgical interventions. The BFMS (NAGI stent) is longer and larger than the prototype AXIOS-LAMS, which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.

Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Introduction: Benign anastomosis stenosis may develop in postoperative or long term period due to many reasons such as anastomosis leakage and anastomosis ischemia after colorectal surgery. While surgical treatment was commonly used in benign anastomosis stenosis in the past, surgery has left its place to more minimally invasive methods such as endoscopic treatments. There is no gold standard treatment method in the management of benign anastomosis strictures in the literature. In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Material and Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Discussion and Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented. Keywords: Rectal Neoplasms, Stenosis, Laparoscopy, Anastomostic stenosis