Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes

Xinopoulos, Dimitrios; Kypreos, Dimitrios; Bassioukas, Stefanos P.; Korkolis, Dimitrios; Mavridis, Konstantinos; Scorilas, Andreas; Dimitroulopoulos, Dimitrios; Loukou, Argyro; Paraskevas, E.

doi:10.1007/s00464-010-1247-z

Cited by 20 publications

(10 citation statements)

References 33 publications

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“…7 its overall success rate is about 70% to 90%, but it usually requires repeated sessions and different or combining techniques because of stricture recurrence. [23][24][25] even when successful, endoscopic treatment has been shown in 2 comparative studies to result in significantly impaired health-related quality of life in patients compared with healthy subjects serving as surgical controls. 31,32 endoscopic treatment usually fails when stenosis appears late or when it is long, because of ischemic phenomena with the development of nonexpandable fibrotic tissues and a rigid colon.…”

Section: Discussionmentioning

confidence: 98%

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Genser

Manceau

Karoui

et al. 2013

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 98%

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Genser

Manceau

Karoui

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…Another group has shown that bougie dilators are more cost-effective than endoscopic dilators for postoperative benign rectal strictures as well as being equally safe and efficacious. 5 All patients in this report had colonic CD. Since beginning anti-tumour necrosis factor therapy, 3 of 4 patients require stricture dilation much less frequently.…”

Section: Resultsmentioning

confidence: 65%

Bougie dilators: simple, safe and cost-effective treatment for Crohn’s-related fibrotic anal strictures

et al. 2015

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Anal strictures with fibrotic induration have been shown to develop in up to 50% of all patients with Crohn's disease (CD) with anal ulceration.1 Clinically significant strictures occur in about 5% of patients with perianal CD. With reduced stool consistency due to the CD, symptoms are often minimal, and the stricture is discovered at examination. When present, the stricture-related symptoms are overflow diarrhea, perineal pain, constipation and/or fecal incontinence.In the past, dilation was digital or with Hegar dilators. More recently, balloon dilation has become the choice for many, 2 entailing a considerable longterm cost. To the best of our knowledge, there are no published case series of bougie dilation of CD anal strictures. This discussion demonstrates the technical feasibility, safety, long-term efficacy and cost-effectiveness of bougienage for a subgroup of patients with CD-related fibrotic anal strictures.Ten patients with CD at a single university teaching hospital who had symptomatic fibrotic anal strictures and failure of digital dilation and were treated between 1988 and 2013 were all perceived to have irreversible fibrotic anal strictures (Cardiff classification S2a).3 They all had symptoms, such as narrowing stools, abdominal distension and overflow diarrhea. All were further characterized by the inability of a single experienced clinician to insert the distal interphalangeal joint of the examining index finger through the stricture. All strictures were 2 cm long or less, except in 1 patient who opted for colostomy. Bougie dilation techniqueWith the patient in the left lateral position and without any prior bowel preparation, stricture dilation was performed using generously lubricated silicone bougies with a tapered Maloney tip (M-Flex, Medovations). Intravenous sedation with fentanyl and diazepam was given. Despite an initial estimated stricture diameter of 5-6 mm in all patients, the procedure was initiated with a # 40-to 44-French bougie. The usual number of bougies per session was 4-5, starting with a 40-or 44-French, and going by double sizes to 40, 44, 48, 52, 56, 60). Ultimately, dilation up to the biggest bougie (60-French) was achieved in all patients. With the passage of a bougie through a stricture there is often a sensation of it giving way; once this is felt, one knows that the maximum diameter of the bougie has been passed through the stricture. All procedures were performed by a single experienced physician in an endoscopy suite. A total of 308 procedures were performed. Treatment intervals varied according to patient demand.The median age of patients at first therapy was 42 (interquartile range 25-50) years with a median follow-up of 10 (range 6-25) years. Dilation was

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“…This method provides tactile feedback, which makes it possible to estimate the degree of resistance to the dilatator passage, and thus avoid overdilation. Another study comparing bougies versus balloons in the treatment of benign postoperative rectal strictures, in a total of 39 patients did not objectify a statistically significant difference between the two groups concerning the success rate, major complications, number of necessary dilations, or recurrence, the only advantage was the low cost of the bougies [21]. In fact, unlike balloons, bougies are reusable.…”

Section: Discussionmentioning

confidence: 97%

Management of Crohn's Anal Strictures: The Experience of a Department of Medicine

N¹,

H²,

Benzzoubeir³

et al. 2020

SJAMS

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Original Research ArticleCrohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. Perineal manifestations are a marker for disease severity. Anal strictures result from fibrotic scarring after several inflammatory attacks and are responsible for impaired quality of life. The aim of our work is to study the epidemiological profile and the management of these lesions. Methods: This is a descriptive retrospective study over a 17-year period from January 2002 to January 2019, concerning a monocentric cohort of 1053 cases of Crohn's disease. Results: 22 patients had anal stricture, a prevalence rate of 2.08%. The main symptoms were painful passing of stools in all patients, emission of pus in 12 patients (54.5%) cases, imperiosity in 5 patients (22.7%), abdominal pain in 10 patients (45.4%) and an obstructed defecation syndrome in 3 patients (13.6%). Penetrating phenotype B3 and the colonic localization L2 were the most frequent. Pelvic MRI confirmed anal stenosis in all patients, associated with complex fistulas PARKS grade 4 in 18% (n = 4) cases. Treatment of the stenosis consisted of finger dilatation in 21 patients (90%), associated with dilation by Hegar dilatators in 63.6% (n = 14) cases and by balloon in 31.8% (n = 7) cases; the stenosis biopsy revealed squamous cell carcinoma in only one case, 4.5%. Medical treatment for CD was based on immunosuppressants in 72.7% (n = 16) cases, anti TNF in 18.18% (n = 4) cases and Combination therapy in 9% (n = 2) cases. Conclusion: The prevalence of anal strictures in our study remains low compared to literature series; these are young women with LAP, a Penetrating phenotype and pancolitis.

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Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes

Cited by 20 publications

References 33 publications

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

Bougie dilators: simple, safe and cost-effective treatment for Crohn’s-related fibrotic anal strictures

Management of Crohn's Anal Strictures: The Experience of a Department of Medicine

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