Endoscopic dilation of colonic postoperative strictures

Abstract

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.

Endoscopic treatment of postoperative colorectal anastomotic strictures

“…We can only speculate on the true contributory significance of these factors for stricture formation since comparisons with the patients who recovered uneventfully without developing an anastomotic stricture are not available. The relevance of these factors remains controversial, and no prospective studies are currently under way [5,10,16].…”

Endoskopische therapie benigner anastomosenstenosen im kolon- und rektumbereich durch elektroinzision und ballondilatation

“…Die Anastomosenstenosen k6nnen nach Jahrzehnten auftreten, h/iufig sind sie aber in den ersten 6 Monaten postoperativ zu beobachten [14,15]. Bei unseren 21 Patienten wurde die Anastomosenstenose 3-12 Monate postoperativ diagnostiziert.…”

Balloon Dilatation of Benign Rectal Anastomotic Strictures – A Review

“…Skreden et al [10] reported that symptomatic relief was obtained in 10 of 11 patients (90.9%) with 10 (SD 7, range 1-24) months of followup, and the remaining patient 'had diarrhoea until death from cardiac failure a year later' . Pietropaolo et al [14] reported a failure rate of 2.4% (1/42) in their series. They also concluded that success of a single session of endoscopic dilatation (76.9%) was significantly higher than bougienage (51.8%).…”

“…The rest of the patients underwent laser incision only (12/94, 12.7%) or bougienage (4/94, 4%) as treatment of stricture. Di Giorgio et al [6] compared endoscopic with fluoroscopic dilatation in a prospective comparative study and Pietropaolo et al [14] compared endoscopic dilatation with bougienage (table 2). Outcomes Dilatation of strictures was not associated with any mortality.…”