Rectal strictures: treatment with fluoroscopically guided balloon dilation.

Abstract

The authors performed 25 fluoroscopically guided balloon dilation procedures in nine patients with rectal strictures. In all cases, the stricture developed after rectal surgery. Four patients underwent ileoanal anastomosis after total colectomy for various conditions; five patients underwent rectosigmoid end-to-end anastomosis after resection of a tumor or as treatment for diverticulitis. Maximal stricture dilatation was attained in 20 instances with a single 15-30-mm balloon. In five procedures, two balloons (20 or 15 mm) were inflated simultaneously ("kissing balloons" technique) to dilate the strictures. In five patients, only one dilation procedure was required for effective treatment of the strictures, with no clinical evidence of strictures after follow-up of 1.5-56 months (mean, 29.5 months). In the other four patients, multiple procedures were performed: nine in one patient, five in one patient, and three in two patients. In these patients, no recurrent symptoms developed during follow-up of 1.25-18 months (mean, 8.1 months) after the last dilation. Complicating leaks, infection, or hemorrhage did not occur after any of the procedures. Fluoroscopically guided balloon dilation is a safe and effective procedure for the treatment of rectal strictures.

Endoscopic alternatives in managing anastomotic strictures of the colon and rectum

“…A mean of 2.5 treatments per patient (range, 1-13) was required. Other series have reported success rates of 33%-100% (as defined by a normal bowel habit) following various methods of dilatation but up to 88% of patients required repeat procedures [8,14,[16][17][18][19][20][21][22][23]. Garcea et al [13], in a review of therapeutic procedures for benign rectal strictures, suggested that balloon dilatation was most appropriate for short strictures but if multiple dilatations were required, then other techniques such as open surgery, transanal stricturoplasty or endoscopic stricturoplasty should be considered.…”

The Strictured Anastomosis: Successful Treatment by Corticosteroid Injections—Report of Three Cases and Review of the Literature

“…More severe strictures may require more aggressive dilation, strictureoplasty, or repeat resection. 2,[8][9][10] Before attempts at more aggressive intervention are made, recurrent cancer should be excluded and the stricture anatomy clearly defined with endoscopy, contrast examination, or both.…”

Treatment of Colorectal Stricture After Circular Stapling Anastomoses

“…Tension free anastomosis is highly recommended to the low anterior resection (Shimada et al, 2007). Most of the anastmotic strictures are short narrowings less than 1 cm that can be successfully treated by an esophageal bougie or a balloon dilator (Johansson, 1996;Kozarek, 1986;Lange & Shaffer, 1991;Oz & Forde, 1990;Schlegel et al, 2001;Werre et al, 2000). In our study, all stenoses were irregular, kinked, fixed, and long (mean ± SD = 1.7 ± 0.4 cm).…”

“…Accordingly, this type of stricture is usually resistant to conventional treatment, resulted in surgical reoperation or the need for permanent stoma (Bailey et al, 2003;Köhler et al, 2000;Ohman & Svenberg, 1983). Recent advances in fluoroscopic and endoscopic modalities enable us to perform an effective, relatively safe, and less invasive treatment such as fluoroscopically guided bougienage, balloon dilation or endoscopic modalities for these patients who experience acute, recurrent, or chronic stricture of the alimentary tract (Garcea et al, 2003;Johansson, 1996;Kozarek, 1986;Lange & Shaffer, 1991;Oz & Forde, 1990;Werre et al, 2000). Good clinical results have been obtained in the simple gastrointestinal anastomotic strictures.…”