Efficacy and safety of endoscopic radial incision and cutting for benign severe anastomotic stricture after surgery for lower rectal cancer (with video)

Osera, Shozo; Ikematsu, Hiroaki; Odagaki, Tomoyuki; Oono, Yasuhiro; Yano, Tomonori; Kobayashi, Akihiro; Ito, Masaaki; Saitô, Norio; Kaneko, Kazuhiro

doi:10.1016/j.gie.2014.11.011

Cited by 32 publications

(34 citation statements)

References 10 publications

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“…Three studies described the application of EECI: a case report from Germany [ 4 ], a case series from Korea [ 7 ] and a retrospective case series from Italy [ 9 ]. Three studies described an endoscopic electrocautery radial incision and cutting (RIC) technique: one case report from Brazil [ 5 ], a retrospective case series from Japan [ 8 ] and a prospective study from Italy [ 10 ]. A case report from USA described the use of adjunctive corticosteroids with EECI [ 6 ].…”

Section: Resultsmentioning

confidence: 99%

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Jain¹,

Sandhu

Singhal

2017

aog

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Benign anastomotic strictures can occur in up to 22% of patients who undergo colonic or rectal resection. Traditionally, surgery was the preferred method of treatment, but, over time, endoscopic techniques, such as balloon dilation, have become the preferred modality. However, a high stricture recurrence rate of up to 18-20% and the increased risk of perforation due to uncontrolled stretching are its major drawbacks. Endoscopic electrocautery incision (EECI) allows for controlled mucosal incision in predetermined locations of stricture. In this meta-analysis, we have summarized case reports, case series, retrospective studies and prospective studies describing the different endoscopic EECI techniques used for benign lower gastrointestinal tract anastomotic strictures. Our analysis showed that EECI, either alone or in combination with other modalities (e.g. balloon dilation, steroid injection or argon plasma coagulation) is an effective treatment option for both treatment-naïve and refractory short non-inflammatory strictures. The overall success rate for EECI-based therapy for benign colorectal stricture was 98.4%, with a stricture recurrence rate of 6.0%. No major adverse event (bleeding, infection or perforation) was reported. Only minor adverse events (abdominal pain) were reported in 3.8% of the population.

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Section: Resultsmentioning

confidence: 99%

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Jain¹,

Sandhu

Singhal

2017

aog

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“…We successfully conducted RIC in five CD patients with intestinal strictures. There are some case reports regarding RIC for colorectal strictures [7][8][9] after surgery for colorectal cancers. However, there is only one report about endoscopic dilation resembling RIC for CD intestinal stricture [10].…”

Section: Discussionmentioning

confidence: 99%

“…Although one of the five patients developed delayed bleeding, endoscopic hemostasis was safely performed. Other case series of RIC for colorectal anastomosis and NKSt also report performance of these techniques safely and with low complication rates (delayed bleeding: 0 % to 3.3 %, perforation: 0 % to 0.4 %) [7][8][9][10]. Second, the indication for RIC is controversial.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic radial incision and cutting for Crohn’s Disease-associated intestinal stricture: a pilot study

et al. 2020

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Background and study aims Intestinal stricture associated with Crohn’s disease (CD) is usually treated by endoscopic balloon dilation (EBD) or stricture plasty. Although EBD is effective and safe for such strictures, refractory stricture after EBD poses a problem. Hence, other novel approaches for these refractory strictures are required. On the other hand, the efficacy of radial incision and cutting (RIC) method for esophageal stricture after esophagogastric surgery is reported. In this pilot study, we adopted the RIC technique for five CD patients with refractory intestinal stricture to dilate their strictures. We conducted the RIC procedure using an electric needle knife with a ceramic tip on the top of the needle. Four cases were of anastomotic stricture after ileocecal resection and the remaining one case was of stricture due to mucosal healing. The RIC procedure was successful for all five patients. Average procedure time was 18.6 minutes. One patient developed delayed bleeding after RIC. There were no cases of perforation. RIC could be an alternative therapy for intestinal stricture associated with CD. Further studies should be conducted to clarify its efficacy and safety.

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“…Modifications have been made to this technique, withdrawing the tissue from between the radial incisions (RIC: radial incision and cutting) with an IT knife [29,30] or with argon plasma [31], or else combining balloon dilatation with radial incisions (Figures 3 and 4). Other combined treatments give a steroid injection in the incisions to avoid relapse of the stricture.…”

Section: Incisional Therapy (Eei: Endoscopic Electrocautery Incision)mentioning

confidence: 99%

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

García¹,

Pedreño²,

DuránCampos³

et al. 2019

Endoscopy - Novel Techniques and Recent Advancements

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Postsurgical benign colorectal strictures occur in up to 20% of patients who undergo colon or rectal resection. Traditionally, treatment has been surgical, but recent decades have seen the growing importance of an endoscopic approach, particularly balloon dilatation, which is now considered the first-line treatment for these benign strictures. However, balloon dilatation is associated with a recurrence of the stricture in up to 25% of cases. When this arises, one can opt for surgery aimed at performing a reanastomosis; a new intestinal anastomosis may be technically complex or even impossible, which would result in the patient requiring a permanent colostomy, with its consequent negative impact on quality of life. Accordingly, different endoscopic approaches have been evaluated for strictures refractory to balloon dilatation, such as the implant of self-expanding metallic stents, biodegradable stents, or incisional therapy, with variable results in efficacy.

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Efficacy and safety of endoscopic radial incision and cutting for benign severe anastomotic stricture after surgery for lower rectal cancer (with video)

Cited by 32 publications

References 10 publications

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Endoscopic radial incision and cutting for Crohn’s Disease-associated intestinal stricture: a pilot study

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

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