Endoscopic ultrasound‐guided colo‐colostomy for the treatment of benign complete occlusion of colonic anastomosis: a case series and description of technique

Abstract

AimThe incidence of benign colonic anastomotic stricture is approximately 2% in patients undergoing left hemicolectomy or anterior resection and as high as 16% in patients undergoing low anterior or intersphincteric resection. In the majority, rather than complete occlusion, a stenosis forms, which can be managed with endoscopic balloon dilatation, a self‐expanding metallic stent or endoscopic electroincision. In the less common scenario of a completely occluded colonic anastomosis, surgery is often required. In this study, we aim to describe the technique we used to treat this condition non‐operativelyMethodWe describe a case series of three patients with benign complete occlusion of their colorectal anastomosis and how we managed them nonoperatively with a colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a Hot lumen‐apposing metallic stent.ResultsWe demonstrate that the technical and clinical success for this technique is 100%.ConclusionsWe believe that the technique we describe is effective and safe. It should be widely reproducible in centres with expertise in interventional EUS, given the similarity to well‐established procedures such as EUS‐guided gastroenterostomy. Patient selection and timing of reversal of ileostomy need careful consideration, especially in patients with a history of keloid formation. Given the shorter hospital stay and reduced invasiveness of this technique, we believe it should be considered for all patients who have complete benign occlusion of a colonic anastomosis. However, given the small number of cases and short period of follow‐up, the long‐term outcome of this technique is not known. More studies with higher power and a longer period of follow‐up should be conducted to further ascertain the effectiveness of this technique.

Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation

“…Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture.…”

“…Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,[4][5][6].…”

“…Therefore, the alternative method of Philip BC Pang et al can be applied [5]. However, due to limited endoscopic (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture.…”