Two Cases of Electrocautery Incision Therapy Using an Insulated-tip Knife for Treatment of Symptomatic Benign Short-segment Colonic Stenosis Following Colonic Resection

Abstract

Anastomotic stenosis of the colon is not an uncommon finding; however, its frequency varies from one study to another. Traditionally, postoperative colonic stenosis is managed surgically. However, endoscopic therapy has recently become the preferred treatment modality over traditional surgery. Good short-term success has been achieved with use of endoscopic balloon dilation; however, restenosis may occur over time in 14% to 25% of patients. The current report showed the effectiveness and usefulness of an insulated-tip knife (IT-knife) for electrocautery therapy of a patient with symptomatic anastomotic colonic stenosis.

Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

“…Ten original articles were considered appropriate to be included in this review article [ 4 - 13 ]. 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 ].…”

“…The spectrum of surgical resections included those for malignant primary lesions, such as low anterior resection for rectosigmoid colon cancer and rectal cancer, intersphincteric resection for lower rectal cancer, hemicolectomy or subtotal colectomy [ 5 , 7 - 13 ]. Patients undergoing proctocolectomy with ileal-pouch anal anastomosis for ulcerative colitis, sigmoid resection for diverticulitis and volvulus, prophylactic proctocolectomy for familial adenomatous polyposis were also included by some studies in this review [ 4 , 6 , 9 , 10 ].…”

“…The size of the endoscope used varied across the studies, hence creating a wide variability in the stricture definition. Few studies used radiologic techniques, such as barium enema, barium swallow or CT scan, to define the stricture [ 7 , 10 , 11 , 13 ]. The diagnosis in these studies was followed by endoscopic confirmation of the stricture.…”

“…Benign stenosis of colonic, rectal or colorectal anastomosis can occur from as early as within the first postoperative month to as late as several years after the surgery [ 19 ]. Most subjects were diagnosed with a stricture in the first postoperative year [ 4 , 7 - 13 ]. One case reported by Dieuruf et al had a stricture diagnosed 12 years after the surgery [ 6 ].…”

“…The references of pertinent studies were searched manually to identify additional relevant studies. The search yielded case reports [ 4 - 6 ], case series [ 7 - 9 ], and prospective studies [ 10 - 13 ]. The stricture etiology, characteristics and location, device details, procedure details, success rate, complications and limitations were reviewed for each study.…”