1
|
Cheong JY, Connelly TM, Duraes LC, Gorgun E. Endoscopic-Assisted Transanal Minimally Invasive Surgery to Restore Patency of a Benign Colorectal Anastomotic Stricture. Dis Colon Rectum 2023; 66:e1129-e1130. [PMID: 37585278 DOI: 10.1097/dcr.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Ju Yong Cheong
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | | |
Collapse
|
2
|
Wang S, Wan J, Li Z, Long C, Zhang R, Luo Y, Han Z, Yan J. Comparison of the Efficacy of Endoscopic Radial Incision and Cutting Procedure and Endoscopic Balloon Dilation for Benign Anastomotic Stricture After Low Anterior Resection Combined With Preventive Loop Ileostomy in Rectal Cancer. Dis Colon Rectum 2023; 66:1392-1401. [PMID: 37339319 DOI: 10.1097/dcr.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Endoscopic radial incision and cutting procedure is a notable technique in the treatment of benign anastomotic strictures after low anterior resection in rectal cancer. However, the efficacy and safety of the endoscopic radial incision and cutting procedure and traditional endoscopic balloon dilation remain unknown. OBJECTIVE To compare the efficacy and safety of the endoscopic radial incision and cutting procedure and endoscopic balloon dilation in patients with anastomotic stricture after low anterior resection. DESIGN Rectal cancer patients with anastomotic stricture after low anterior resection combined with synchronous preventive loop ileostomy between January 2014 and June 2021 were retrospectively collected. These patients underwent the endoscopic radial incision and cutting procedure or endoscopic balloon dilation as an initial treatment. The clinicopathological baseline data of the patients, endoscopic surgery success rate, complications, and restricture rate were analyzed. SETTINGS This study was conducted at Nanfang Hospital in China. PATIENTS A total of 30 patients were eligible after reviewing the medical records. Twenty patients underwent endoscopic balloon dilation, and 10 patients underwent endoscopic radial incision and cutting procedure. MAIN OUTCOME MEASURES The adverse event rate and stricture recurrence rate. RESULTS There were no significant differences in patient demographics or clinical features. No adverse events occurred in either of the 2 groups. The mean operation time was 18.9 ± 3.6 minutes in the endoscopic balloon dilation group and 10.2 ± 3.3 minutes in the endoscopic radial incision and cutting procedure group ( p < 0.001). The stricture recurrence rates between the endoscopic balloon dilation group and the endoscopic radial incision and cutting procedure group were significantly different (44.4% vs 0%; p = 0.025). LIMITATIONS This was a retrospective study. CONCLUSIONS The endoscopic radial incision and cutting procedure is safe and more efficacious than endoscopic balloon dilation for anastomotic stricture after low anterior resection combined with synchronous preventive loop ileostomy in rectal cancer.
Collapse
Affiliation(s)
- Shijie Wang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jinliang Wan
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhiming Li
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Chenyan Long
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Renyi Zhang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yaxin Luo
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zelong Han
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jun Yan
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| |
Collapse
|
3
|
Hu X, Guo P, Zhang N, Guo G, Li B, Liu Y, Niu J, Wang G. Nomogram for benign anastomotic stricture after surgery for rectal cancer. Asian J Surg 2023; 46:111-119. [PMID: 35190233 DOI: 10.1016/j.asjsur.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/29/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Benign anastomotic stricture remains among the most prevalent complications following surgery for rectal cancer. OBJECTIVE This study is aimed at identifying risk factors of anastomotic stricture as well as generating an effective nomogram for the stricture. METHODS Design: This is a retrospective study. SETTING This study was conducted from January 2015 to December 2019 in a single tertiary center for rectal cancer. PATIENTS A total of 117 rectal cancer patients after surgery without recurrence were enrolled in this study, of which 39 with anastomotic stricture and 78 without stricture. MAIN OUTCOME MEASURES Their clinical and pathological data were collected. Multiple logistic regression analysis was conducted to identify risk factors for anastomotic stricture and to generate the nomogram prediction model. RESULTS Multivariate analysis of the primary cohort led to the identification of LCA (left colic artery) preservation (OR, 0.074; P = 0.0015), protective stoma (OR, 5.353; P = 0.012), anastomotic leakage (OR, 12.027; P = 0.005), and anastomotic distance (OR, 7.578; P = 0.012) as independent risk factors for anastomotic stricture. The following predictive model was derived: Logit (anastomotic stricture) = 0.074∗ LCA + 5.353∗ Protective stoma +12.027∗ Anastomotic leakage + 7.578∗ Anastomotic distance. Assessment of the predictive model revealed that the area under the curve (AUC) was 0.871, while the cutoff value was 15.444 with a sensitivity of 64.1% and a specificity of 94.8%. LIMITATIONS The main limitation is the research design of a retrospective and case-controlled study with a small sample size from a single center. CONCLUSIONS LCA preservation, protective stoma, anastomotic leakage, and anastomotic distance may affect the occurrence of anastomotic stricture following surgery for rectal cancer. The nomogram model generated in the present study can be valuable in the prediction of anastomotic stricture. This study has been registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/, ChiCTR 2100043775).
Collapse
Affiliation(s)
- Xuhua Hu
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Peiyuan Guo
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Ning Zhang
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China; The Department of General Surgery, The First Central Hospital of Baoding, No.320, Changcheng North Street, Baoding, Hebei Province, PR China.
| | - Ganlin Guo
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Baokun Li
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Youqiang Liu
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Jian Niu
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China.
| | - Guiying Wang
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, NO.12, JianKang Road, Shijiazhuang, Hebei Province, PR China; The Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, NO.139, Ziqiang Road, Shijiazhuang, Hebei Province, PR China.
| |
Collapse
|
4
|
Inoue T, Shichijo S, Yasui M, Takeuchi Y, Michida T, Ishihara R. Endoscopic incision and balloon dilation using the rendezvous technique for complete anastomotic obstruction after rectal low-anterior resection. Endoscopy 2022; 54:E90-E91. [PMID: 33723840 DOI: 10.1055/a-1393-5165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Takahiro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
5
|
Clifford RE, Fowler H, Manu N, Vimalachandran D. Management of benign anastomotic strictures following rectal resection: a systematic review. Colorectal Dis 2021; 23:3090-3100. [PMID: 34374203 DOI: 10.1111/codi.15865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
AIM Benign anastomotic strictures following colorectal surgical resection are a commonly under-reported complication in up to 30% of patients, with a significant impact upon quality of life. In this systematic review, we aim to assess the utility of endoscopic techniques in avoiding the need for surgical reintervention. METHOD A literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases. Additional papers were found by scanning the references of relevant papers. RESULTS A total of 34 papers were included, focusing upon balloon dilatation, endoscopic stenting, electroincision, stapler stricturoplasty and cortiocosteroids alone and in combination, with success rates varying from 20% to 100%. The most challenging strictures were reported as those with a narrow lumen, frequently observed following neoadjuvant chemoradiotherapy or an anastomotic leak. Endoscopic balloon dilatation was the most commonly used first-line method; however, repeated dilatations were often required and this was associated with an increased risk of perforation. Although initial success rates for stents were good, patients often experienced stent migration and local symptoms. Only a small number of patients experienced endoscopic management failure and progressed to surgical intervention. CONCLUSION Following identification of an anastomotic stricture and exclusion of underlying malignancy, endoscopic management is both safe and feasible as a first-line option, even if multiple treatment exposures or multimodal management is required. Surgical resection or a defunctioning stoma should be reserved for emergency or failed cases. Further research is required into multimodal and novel therapies to improve quality of life for these patients.
Collapse
Affiliation(s)
| | - Hayley Fowler
- Institute of Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Nicola Manu
- The Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Dale Vimalachandran
- Institute of Cancer Medicine, The University of Liverpool, Liverpool, UK.,The Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| |
Collapse
|
6
|
Lightner AL. Applying Endoscopic Interventions to Inflammatory Bowel Disease-Related Strictures. CROHN'S & COLITIS 360 2020; 2:otaa066. [PMID: 36777749 PMCID: PMC9802366 DOI: 10.1093/crocol/otaa066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA,Address correspondence to: Amy L. Lightner, MD, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 ()
| |
Collapse
|
7
|
Mercan Ü, Erşen O, Yüksel C, Yalkın Ö, Akbulut S, Ünal E, Demirci S. Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2020. [DOI: 10.46327/msrjg.1.000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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
Collapse
|
8
|
Jeong SJ, Park J. Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction. Clin Endosc 2019; 53:18-28. [PMID: 31645090 PMCID: PMC7003002 DOI: 10.5946/ce.2019.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.
Collapse
Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
9
|
Zhang LJ, Lan N, Wu XR, Shen B. Endoscopic stricturotomy in the treatment of anastomotic strictures in inflammatory bowel disease (IBD) and non-IBD patients. Gastroenterol Rep (Oxf) 2019; 8:143-150. [PMID: 32280474 PMCID: PMC7136702 DOI: 10.1093/gastro/goz051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/06/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Backgrounds Endoscopic stricturotomy (ESt) has been shown to be effective in treating inflammatory bowel disease (IBD)-associated anastomotic strictures. However, the outcome of ESt in benign, non-IBD conditions has not been described. The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures. Methods Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted. The primary outcomes were surgery-free survival and procedure-related complications. Results A total of 49 IBD and 15 non-IBD patients were included in this study. The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches. Underlying diseases in the non-IBD group included colorectal cancer (n = 7), diverticulitis (n = 5), large bowel prolapse (n = 2), and constipation (n = 1). Immediate technical success was achieved in all patients in both groups. Bleeding complications occurred on five occasions (4.7% per procedure) in the IBD group, while no complication occurred in the non-IBD group (P = 0.20). Stricture improvement on follow-up endoscopy was found in 10 (20.4%) and 5 (33.3%) patients in the IBD and non-IBD groups, respectively (P = 0.32). Six (12.2%) patients in the IBD group and four (26.7%) patients in the non-IBD group eventually required stricture-related surgery (P = 0.23). IBD patients appeared to have a higher tendency for maintaining surgery-free after the procedure than non-IBD patients (P = 0.08). Conclusions Endoscopic stricturotomy was shown to have comparable outcomes, though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.
Collapse
Affiliation(s)
- Long-Juan Zhang
- Laboratory of General Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.,Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nan Lan
- Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xian-Rui Wu
- Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Bo Shen
- Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
10
|
Retrospective multicenter study of post-operative stenosis after stapled colorectal anastomosis. Updates Surg 2018; 71:539-542. [PMID: 30073626 DOI: 10.1007/s13304-018-0575-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/23/2018] [Indexed: 01/27/2023]
Abstract
Anastomotic stenosis after colorectal surgery is usually considered low-rate complication and often is under-reported in most studies. Few data are available on management strategies. The aim of the study was to assess the prevalence of stenosis after stapled colorectal anastomosis, performed either in elective or emergent setting, for benign or malignant disease, and to evaluate treatment profiles. This retrospective study was a survey conducted in a large Italian North-Eastern area including three regions (Triveneto), over a 12-month period (January-December 2015). Patients' characteristics and surgical technique details were recorded, along with data on the prevalence of stenosis and its treatment. Patients with mid or low rectal resection and/or neoadjuvant chemo-radio therapy and/or diverting stoma were excluded. The study was promoted by the Italian Association of Hospital Surgeons (ACOI) and the Society of Surgeons of the Triveneto Region. Twenty-eight surgical units were enrolled in the survey, accounting for over 1400 patients studied. Fifty percent of the units performed laparoscopically > 70% of the colorectal resections and 7.5% of the procedures were emergent. Less than 60% of the units planned regular endoscopic follow-up after colorectal resection. Anastomotic stricture was recorded in 2% of the patients; 88% of the stenoses were diagnosed within 6 months from surgery. Only one anastomotic stricture required re-do surgery. The CANSAS study confirms that colorectal anastomotic stenosis is low-rate-but still present-complication. Treatment strategies vary according to surgeons' and endoscopists' preferences. Commonly endoscopic dilatation is preferred, but re-do surgery is required in some cases.
Collapse
|
11
|
Chen Q, Yu Q, Yu JJ, Liu M, Xie HP, Cheng B, Guao QZ, Liao GQ, Qin H. Observational study of colonoscopy techniques used for acute colorectal obstruction: A single-center experience. Mol Clin Oncol 2017; 6:355-361. [PMID: 28451412 PMCID: PMC5403636 DOI: 10.3892/mco.2017.1133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022] Open
Abstract
The prevalence of acute colorectal obstruction at the hospital setting is high. There is need for improvement in the quality of colonoscopy for relieving obstruction. A retrospective, uncontrolled, open-label study was conducted, with the aim of documenting the causes of acute colorectal obstruction and the quality of colonoscopy practice in managing obstruction at a university hospital in China. A total of 61 adult patients with acute colorectal obstruction treated with urgent colonoscopy between February, 2011 and January, 2016 were identified at the Endoscopic Unit of Tongji Hospital (Wuhan, China). The technique success rate was the primary outcome. The etiology was mainly related to malignant diseases, including colorectal cancer in 53 patients (86.9%) and advanced peritoneal serous carcinoma leading to extrinsic colonic compression in 1 patient (1.6%). Benign causes of obstruction included foreign bodies in 3 patients (4.9%) and fecal impaction in 2 patients (3.3%); furthermore, anastomotic strictures were found in 2 patients (3.3%). The technique success rate was 98.4% (60/61). All colorectal cancer patients who underwent urgent colonoscopy were admitted to the Department of Surgery for placement of a self-expanding metallic stent; 1 patient who had an extracolonic malignancy underwent placement of a transanal colonoscopic decompression tube as palliative therapy and 2 patients with anastomotic strictures underwent endoscopic balloon dilation. Furthermore, colonoscopy was used for extracting the foreign body, as well as removing fecal stones in all the patients. In conclusion, urgent colonoscopy as a minimal invasive approach is associated with certain advantages for diagnosing and managing acute colorectal obstruction. Furthermore, experienced operators achieved a better outcome when managing colorectal obstruction.
Collapse
Affiliation(s)
- Qian Chen
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Qin Yu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Jing-Jing Yu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Mei Liu
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Hua-Ping Xie
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Bin Cheng
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Qiao-Zhen Guao
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Guang-Quan Liao
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Hua Qin
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| |
Collapse
|
12
|
Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis. Surg Laparosc Endosc Percutan Tech 2016; 25:138-42. [PMID: 25122484 DOI: 10.1097/sle.0000000000000090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Endoscopic balloon dilatation (EBD) is currently accepted as an effective, safe, and first-line treatment of postoperative benign gastrointestinal anastomosis stenosis (BGAS); however, a limited number of publications on the subject exist in the literature. The aim of the study was to retrospectively evaluate the efficiency of endoscopic dilatation in patients with postoperative intestinal anastomotic stenoses at a single surgical center. METHODS Patients with postoperative BGAS treated by EBD at our institution from February 2008 to 2012 were included. The dilatations were all performed using through-the-scope balloons. The balloon was introduced into the stricture using a guidewire under radiologic guidance. Each dilatation session consisted of 2 to 3 two-minute multistep inflations of the balloon until adequate dilatation was achieved. RESULTS Of the 48 patients included in the study, 44 patients (91.7%) fully recovered and 4 (8.3%) did not respond to treatment. The mean follow-up period was 24 months (range, 3 to 57 mo). Four patients who did not respond to the procedure were treated surgically. Two patients (4.1%) with intestinal perforation during EBD were treated conservatively with a stent. CONCLUSIONS EBD has a low rate of complications and a high success rate, is well tolerated, and avoids further surgical procedures for BGAS. Therefore, EBD should be the first choice of treatment for postoperative anastomotic stenoses.
Collapse
|
13
|
Park CH, Yoon JY, Park SJ, Cheon JH, Kim TI, Lee SK, Lee YC, Kim WH, Hong SP. Clinical efficacy of endoscopic treatment for benign colorectal stricture: balloon dilatation versus stenting. Gut Liver 2015; 9:73-9. [PMID: 25170060 PMCID: PMC4282860 DOI: 10.5009/gnl13326] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS There has been a lack of research comparing balloon dilatation and self-expandable metal stent (SEMS) placement to determine which is better for long-term clinical outcomes in patients with benign colorectal strictures. We aimed to compare the clinical efficacy and complication rates of balloon dilatation and SEMS placement for benign colorectal strictures from a variety of causes. METHODS Between January 1999 and January 2012, a total of 43 consecutive patients who underwent endoscopic treatment for benign colorectal stricture (balloon only in 29 patients, SEMS only in seven patients, and both procedures in seven patients) were retrospectively reviewed. RESULTS Thirty-six patients underwent endoscopic balloon dilatation, representing 65 individual sessions, and 14 patients received a total of 17 SEMS placements. The initial clinical success rates were similar in both groups (balloon vs SEMS, 89.1% vs 87.5%). Although the reobstruction rates were similar in both groups (balloon vs SEMS, 54.4% vs. 57.1%), the duration of patency was significantly longer in the balloon dilatation group compared with the SEMS group (65.5±13.3 months vs. 2.0±0.6 months, p=0.031). CONCLUSIONS Endoscopic balloon dilatation is safe and effective as an initial treatment for benign colorectal stricture and as an alternative treatment for recurrent strictures.
Collapse
Affiliation(s)
- Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Irani S, Kozarek RA. Techniques and principles of endoscopic treatment of benign gastrointestinal strictures. Curr Opin Gastroenterol 2015; 31:339-50. [PMID: 26247823 DOI: 10.1097/mog.0000000000000200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The fundamental goal of treating any stenosis is luminal enlargement to ameliorate the underlying obstructive symptoms. Symptoms depend on the etiology and the site of the stricture and may include dysphagia, nausea and vomiting, abdominal pain, obstipation, or frank bowel obstruction. This article compares the various current technologies available for the treatment of gastrointestinal stenoses with regard to ease and site of application, patient tolerance, safety and efficacy data, and cost-benefit ratio. RECENT FINDINGS Recent studies indicate that gastrointestinal dilation and stenting have evolved to a point at which in many if not most situations they can be the first line therapy and potentially the final therapy needed to treat the underlying condition. SUMMARY Following techniques and principles in the management of gastrointestinal strictures would allow for the well tolerated and effective treatment of most patients with the tools currently available today.
Collapse
Affiliation(s)
- Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | | |
Collapse
|
15
|
Comparable short- and long-term outcomes of colonoscopic balloon dilation of Crohn's Disease and benign non-Crohn's Disease strictures. Inflamm Bowel Dis 2014; 20:1739-46. [PMID: 25153504 DOI: 10.1097/mib.0000000000000145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The response of Crohn's disease (CD) stricture to endoscopic therapy compared with non-CD stricture is unknown. Our aim was to compare the short- and long-term outcomes of endoscopic management of those strictures. METHODS All eligible patients with benign non-CD strictures who underwent the endoscopic balloon dilation between January 2002 and September 2013 were included. Patients with CD strictures were randomly selected with a ratio (CD versus non-CD strictures) of 2:1. RESULTS A total of 90 patients were included, including 30 (33.3%) with non-CD strictures and 60 (66.7%) with CD strictures. Patients with CD strictures were younger than those with non-CD strictures at the time of disease diagnosis (25.8 ± 11.1 versus 50.5 ± 17.5; P < 0.001) and at the time of the first dilation (43.9 ± 12.4 versus 55.8 ± 13.9; P < 0.001). There were no significant differences in characteristics of strictures and their endoscopic treatments between the CD and non-CD groups, except for the percentage of patients who were ever treated with intralesional corticosteroid injection (25.0% versus 6.7%, P = 0.046). Patients in the 2 groups had similar technical success rates (94.0% versus 93.9%, P = 1.00). Few patients in CD stricture group required emergency room visits due to obstructive symptoms from recurrence of disease (1.7% versus 16.7%, P = 0.02). There were on procedure-related complications in either of the 2 groups. CONCLUSIONS The efficacy and safety of endoscopic balloon dilation in the treatment of CD and non-CD strictures seemed to be comparable.
Collapse
|
16
|
Chen TA, Hsu WL. Successful treatment of colorectal anastomotic stricture by using sphincterotomes. Front Surg 2014; 1:22. [PMID: 25593946 PMCID: PMC4286977 DOI: 10.3389/fsurg.2014.00022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/03/2014] [Indexed: 11/13/2022] Open
Abstract
Colorectal or colocolic anastomotic stricture is a common complication after colorectal surgery. Traditionally, endoscopic balloon dilation technique was used for those patients with symptomatic stricture. The use of electroincision (radial incisions of the scar) along with pneumatic balloon dilation was reported with good result in literature. We present a novel method for relieving colorectal anastomotic stricture by using sphincterotomes, which is indicated for use in the cannulation of the biliary ducts and the transendoscopic sphincterotomy of the papilla of Vater and the sphincter of Oddi. The use of sphincterotomes in upper GI tract anastomotic stricture was reported before, but the experience in managing lower GI tract was pending. Based on our preliminary report, sphincterotomes can be an effective and safe treatment option for colorectal anastomotic stricture.
Collapse
Affiliation(s)
- Tzu-An Chen
- Division of Colorectal Surgery, Department of Surgery, Taiwan Landseed Hospital , Taoyuan , Taiwan
| | - Wei-Lun Hsu
- Division of Gastroenterology, Department of Internal Medicine, Taiwan Landseed Hospital , Taoyuan , Taiwan
| |
Collapse
|
17
|
Lee HJ, Park W, Lee H, Lee KH, Park JC, Shin SK, Lee SK, Lee YC, Noh SH. Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer. Gut Liver 2014; 8:394-9. [PMID: 25071904 PMCID: PMC4113056 DOI: 10.5009/gnl.2014.8.4.394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/29/2013] [Accepted: 07/16/2013] [Indexed: 12/27/2022] Open
Abstract
Background/Aims The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. Methods Gastric cancer patients who underwent endoscopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. Results Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/m2 vs 22.46 kg/m2), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. Conclusions Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision.
Collapse
Affiliation(s)
- Hyun Jik Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Ho Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Raimondo D, Facella T, Rossi F, Sinagra E, Di Caro S. Endoscopic rendezvous in stricture of colorectal anastomosis: a new approach. Dig Liver Dis 2013; 45:1063-4. [PMID: 23906518 DOI: 10.1016/j.dld.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/02/2013] [Accepted: 06/12/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Dario Raimondo
- Department of Gastroenterology and Digestive Endoscopy, San Raffaele-Giglio Hospital, Cefalù, Italy.
| | | | | | | | | |
Collapse
|
19
|
Manta R, Magno L, Conigliaro R, Caruso A, Bertani H, Manno M, Zullo A, Frazzoni M, Bassotti G, Galloro G. Endoscopic repair of post-surgical gastrointestinal complications. Dig Liver Dis 2013; 45:879-85. [PMID: 23623147 DOI: 10.1016/j.dld.2013.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/28/2013] [Accepted: 03/09/2013] [Indexed: 12/11/2022]
Abstract
Complications following gastrointestinal surgery may require re-intervention, can lead to prolonged hospitalization, and significantly increase health costs. Some complications, such as anastomotic leakage, fistula, and stricture require a multidisciplinary approach. Therapeutic endoscopy may play a pivotal role in these conditions, allowing minimally invasive treatment. Different endoscopic approaches, including fibrin glue injection, endoclips, self-expanding stents, and endoscopic vacuum-assisted devices have been introduced for both anastomotic leakage and fistula treatment. Similarly endoscopic treatments, such as endoscopic dilation, incisional therapy, and self-expanding stents have been used for anastomotic strictures. All these techniques can be safely performed by skilled endoscopists, and may achieve a high technical success rate in both the upper and lower gastrointestinal tract. Here we will review the endoscopic management of post-surgical complications; these techniques should be considered as first-line approach in selected patients, allowing to avoid re-operation, reduce hospital stay, and decrease costs.
Collapse
Affiliation(s)
- Raffaele Manta
- Gastroenterology and Endoscopy Unit, New S. Agostino Hospital, Modena, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization? Tech Coloproctol 2012; 17:371-5. [PMID: 23229558 DOI: 10.1007/s10151-012-0929-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Anastomotic stricture or stenosis is a well-described complication of intestinal anastomosis. The incidence of stricture after colorectal anastomosis ranges from 0 to 30 %. The aim of this study was to identify possible factors related to postoperative colorectal anastomotic stricture and to indicate reoperative surgery outcomes. METHODS After institutional review board approval, medical records were reviewed for patients who underwent surgery for colorectal anastomotic stricture at Cleveland Clinic Florida between January 2001 and December 2010. The main outcome measures were demographics, indications for initial surgery, body mass index, comorbidities, previous treatment, level of anastomosis, history of radiotherapy, and operative data for the reoperative surgery. RESULTS Nineteen patients (15 males) were eligible for the study. Nine patients had a diagnosis of cancer, 7 of whom received radiotherapy. The initial surgeries were low anterior resection (n = 9; 47.4 %), high anterior resection (n = 9; 47.4 %), and sigmoidectomy (n = 1; 5.2 %). Six patients (31.6 %) had anastomotic leak after initial surgery. The majority of the patients (n = 17; 89.5 %) had an intact splenic flexure, inferior mesenteric artery, and inferior mesenteric vein. In all patients, full mobilization of the splenic flexure and high ligation of the mesenteric vessels was performed. Seven patients (36 %) developed postoperative complications. Over a mean follow-up of 24.3 months, there was no recurrence of anastomotic stricture. CONCLUSIONS An intact splenic flexure and mesenteric vessels were the most prevalent in patients who underwent reoperation at our institution. Full mobilization of the splenic flexure, high ligation of the mesenteric vessels, anastomotic stricture resection, and re-anastomosis can be successfully performed with satisfactory outcomes.
Collapse
|
22
|
Ragg J, Garimella V, Cast J, Hunter IA, Hartley JE. Balloon dilatation of benign rectal anastomotic strictures -- a review. Dig Surg 2012; 29:287-91. [PMID: 22922944 DOI: 10.1159/000341657] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/05/2012] [Indexed: 12/10/2022]
Abstract
BACKGROUND The occurrence of anastomotic stricture at the level of the rectum gives rise to three broad therapeutic options, namely major pelvic and abdominal revisional surgery, faecal diversion (stoma), or local revision by transanal approaches (including endoscopic and fluoroscopic). This article updates the current evidence and focuses on the results of the balloon dilatation technique. METHODS A Medline search was carried out using the search terms (dilatation OR dilatation) AND (stricture OR strictures OR stenosis OR stenotic) AND (rectum OR rectal). In an effort to lessen publication bias, articles included at least 10 patients who were consecutively referred for treatment. RESULTS/CONCLUSION This review would suggest that probably relatively short strictures have been chosen for balloon dilatation and that the results have had a very low major morbidity (0.45%) and mortality (0%) rate.
Collapse
Affiliation(s)
- J Ragg
- Academic Surgical Unit, University of Hull, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, East Yorkshire, UK
| | | | | | | | | |
Collapse
|
23
|
Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc 2011; 74:745-52. [PMID: 21951473 DOI: 10.1016/j.gie.2011.07.025] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 12/17/2022]
|
24
|
Curcio G, Spada M, Francesco FD, Tarantino I, Barresi L, Burgio G, Traina M. Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation. World J Gastroenterol 2010; 16:4751-4. [PMID: 20872979 PMCID: PMC2951529 DOI: 10.3748/wjg.v16.i37.4751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife. We report a case of a colorectal anastomosis web occlusion, treated without electrocision. Gastrografin enema and sigmoidoscopy showed complete obstruction at the anastomotic site due to the presence of an anastomotic occlusive web. In order to avoid thermal injuries, we decided to use a suprapapillary biliary puncture catheter. The Artifon catheter was inserted into the center of the circular staple line at the level of the anastomosis, and fluoroscopic identification of the proximal bowel was obtained with dye injection. A 0.025-inch guidewire was then passed through the catheter into the colon and progressive pneumatic dilatation was performed. The successful destruction of the occlusive web facilitated passage of the colonoscope, allowing evaluation of the entire colon and stoma closure after three months of follow-up. The patient tolerated the procedure well, with no complications. This report highlights an alternative non-electrosurgical approach that uses a new device that proved to be safe and useful.
Collapse
|
25
|
Xinopoulos D, Kypreos D, Bassioukas SP, Korkolis D, Mavridis K, Scorilas A, Dimitroulopoulos D, Loukou A, Paraskevas E. Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes. Surg Endosc 2010; 25:756-63. [PMID: 20927548 DOI: 10.1007/s00464-010-1247-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 07/08/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder-Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method. METHODS A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder-Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated. RESULTS Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder-Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 compared with 680 , respectively; p < 0.001). CONCLUSION Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder-Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.
Collapse
|
26
|
Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Ikenberry SO, Jain R, Khan K, Krinsky ML, Maple JT, Shen B, Van Guilder T, Baron TH, Dominitz JA. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71:669-79. [PMID: 20363408 DOI: 10.1016/j.gie.2009.11.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 02/06/2023]
|
27
|
Estenosis anastomóticas benignas en la cirugía radical del cáncer de recto. Resultados del tratamiento con dilatación hidrostática. Cir Esp 2010; 87:239-43. [DOI: 10.1016/j.ciresp.2009.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 12/08/2009] [Accepted: 12/08/2009] [Indexed: 11/15/2022]
|
28
|
Efficacy and safety of endoscopic balloon dilation of benign anastomotic strictures after oncologic anterior rectal resection: report on 24 cases. Surg Laparosc Endosc Percutan Tech 2009; 18:565-8. [PMID: 19098661 DOI: 10.1097/sle.0b013e31818754f4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal anastomotic benign strictures represent a challenging complication. Endoscopic dilation represents a valid and safe treatment. The purpose of this study is to retrospectively investigate the results of endoscopic balloon dilation for anastomotic stricture after anterior rectal resection for cancer in an institution. Twenty-four symptomatic patients with benign colorectal anastomotic stricture were treated between April 2001 and January 2005. All patients underwent dilation using through-the-scope balloon technique. The success of dilation, the number of sessions required, complications, recurrence, and the relationship between the number of dilation sessions and recurrence were assessed. Dilation was successful in 22 (91.7%) patients. There were no procedure-related complications. The mean number of sessions required was 2.3. There was no relationship between the number of dilation sessions and stricture recurrence. Through-the-scope dilation is effective and safe for benign colorectal anastomotic strictures after anterior resection. There was no relationship between the number of dilation sessions and recurrence.
Collapse
|
29
|
Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope and facilitated by SpyGlass (with videos). Gastrointest Endosc 2008; 68:988-92. [PMID: 18984106 DOI: 10.1016/j.gie.2008.05.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 05/06/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND 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. OBJECTIVE To demonstrate a novel endoscopic approach to treat complete colonic anastomotic obstruction. DESIGN Case report. SETTING Tertiary-referral center. PATIENT A 40-year-old woman with a completely obstructed colonic anastomosis after sigmoidectomy for a fibrotic Crohn's stricture. INTERVENTIONS 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. MAIN OUTCOME MEASUREMENTS Technique success and complications. RESULTS The completely obstructed anastomotic stricture was successfully recanalized and dilated by using a single, prototype, forward-array echoendoscope without complications. LIMITATIONS Single case report with a relatively short follow-up interval. CONCLUSIONS 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.
Collapse
|
30
|
Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 2008; 51:1345-9. [PMID: 18454291 DOI: 10.1007/s10350-008-9319-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 12/10/2007] [Accepted: 01/07/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE This prospective study was designed to find the incidence of symptomatic anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease. METHODS Sixty-eight patients who underwent elective laparoscopic sigmoidectomy with double-stapling colorectal anastomosis between November 1998 and June 2007 were included. Follow-up after hospitalization was performed by using sequential rectoscopy for all patients. Symptomatic patients with anastomotic stricture were treated. RESULTS No patient died postoperatively and no patient had anastomotic leak or abdominal septic complication. Twenty-two patients (32 percent) had postoperative symptoms that suggested anastomotic stenosis; 12 of them (17.6 percent) eventually needed dilatation of their anastomosis (median diameter of the stenosis: 7 mm) a mean time of 176 days postoperatively. Eight patients had only one session, three patients had two sessions, and one patient had three sessions. There were no complications and all patients were symptom-free after dilatation. Age, sex, obesity, hypertension, diabetes, and vascular preservation had no influence on the risk of anastomotic stenosis. CONCLUSIONS Incidence of symptomatic anastomotic stenosis after elective laparoscopic sigmoidectomy is high (17.6 percent). No risk factor could be identified. Endoscopic dilatations were successful without complication in all cases. Regular rigid rectoscopy definitely should be part of the postoperative follow-up in symptomatic patients.
Collapse
|
31
|
|
32
|
García-Cano J. Dilation of benign strictures in the esophagus and colon with the polyflex stent: a case series study. Dig Dis Sci 2008; 53:341-6. [PMID: 17565471 DOI: 10.1007/s10620-007-9864-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 04/30/2007] [Indexed: 12/09/2022]
Abstract
Polyflex, a new self-expanding plastic stent (SEPS), is increasingly used to treat obstructions in the gastrointestinal tract. The majority of reports on Polyflex come from tertiary referral centers. This retrospective study describes the efficacy and safety of this new SEPS for the treatment of benign strictures in esophagus and colon and its use in a community hospital. Seven patients were treated from August 2003 through December 2006. All of them presented with severe strictures, and were treated with Polyflex insertion. Four patients had esophageal obstructions (three peptic, one postoperative) and the remaining three patients had postoperative strictures in the rectosigmoid. One patient had a coexisting fistula. Two strictures (one esophageal and another colonic, both postoperative) received the Polyflex as the first line of treatment, without previous sessions of dilation. Esophageal strictures were solved after several consecutive SEPS insertions. Migrated stents were easily extracted from the stomach. On the other hand, colonic strictures achieved permanent dilation with a single stent. The patient with coexisting stricture and fistula became asymptomatic and still had the SEPS in place after four months. The one complication was mild pain after insertion. Polyflex seems to be a useful tool in the dilation of severe benign strictures in esophagus and rectosigmoid and, as in large centers, good results are achieved in a community hospital.
Collapse
Affiliation(s)
- Jesús García-Cano
- Department of Digestive Diseases, Hospital Virgen de la Luz, C/ Federico Mayor Zaragoza, 2, 50, Cuenca 16002, Spain.
| |
Collapse
|
33
|
Nguyen-Tang T, Huber O, Gervaz P, Dumonceau JM. Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses. Surg Endosc 2007; 22:1660-6. [PMID: 18074183 DOI: 10.1007/s00464-007-9679-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 08/30/2007] [Accepted: 10/03/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopic balloon dilation is the first-line treatment for benign colorectal anastomotic strictures. We aimed to objectively assess its long-term results. METHODS Gastrointestinal symptoms and health-related quality of life (HRQoL) were assessed at long-term after balloon dilation of anastomotic strictures in 31 consecutive patients (excluding those with inflammatory bowel disease) as well as and controls, using the validated Gastrointestinal Quality of Life Index (GIQLI). Most colectomies had been performed for benign diseases, with anastomoses located at the colorectal junction. RESULTS Completed surveys were collected from 81 subjects, including 27 study patients (response rate 87%), 27 surgical controls matched for age, gender, and indication of colectomy, and 27 healthy subjects. At a mean of 3.9 +/- 2.3 years after the first endoscopic balloon-dilation, study patients self-reported significantly more gastrointestinal symptoms than controls; these included frequent and urgent bowel movements, bloating, food restriction (p < or = 0.001, all comparisons), diarrhea, excessive passage of gas through the anus (p < 0.01, all comparisons), constipation, and abdominal pain (p < 0.05, all comparisons). Health-related quality of life was significantly impaired in study patients versus surgical controls and healthy subjects (GIQLI scores, 104 +/- 20, 119 +/- 24, and 121 +/- 16, respectively; p = 0.005). Impaired HRQoL subdimensions included gastrointestinal symptoms (p < 0.001), stress by treatment (p < 0.05), and emotional status (p = 0.08). HRQoL was independent of the delay between stricture dilation and the survey. Follow-up endoscopy (performed in 21/27 [78%] study patients, including the 7 patients with the lowest HRQoL, and 19 [70%] surgical controls) disclosed anastomoses larger than 13 mm in all cases. CONCLUSIONS Health-related quality of life is significantly impaired at long-term after standard balloon-dilation of benign anastomotic colorectal strictures as a result of gastrointestinal symptoms and stress by treatment. This impairment might be related to the fact that an anastomotic diameter > or = 13 mm, although commonly used to define successful endoscopic treatment, is insufficient to provide long-term symptom relief in some patients, or to other, yet to be identified, factors.
Collapse
Affiliation(s)
- T Nguyen-Tang
- Service of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest, 24, 1205, Geneva, Switzerland
| | | | | | | |
Collapse
|
34
|
Endoscopic Treatment of Luminal Anastomotic Strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2006. [DOI: 10.1016/j.tgie.2006.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|