Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis

Biraima, Magdalena; Adamina, Michel; Jost, Res; Breitenstein, Stefan; Soll, Christopher

doi:10.1007/s00464-016-4762-8

Cited by 32 publications

(39 citation statements)

References 15 publications

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“…Previous studies have demonstrated that balloon dilation was a safe and effective procedure, with short-term recurrence rates ranging from 6-20% [16,17]. The largest series, which followed 76 patients for a median of 17 years, revealed a long-term success rate of 75% [3]. The present study had observed similar good outcomes, with a 100% primary success rate and a 17.5% recurrence rate.…”

Section: Discussionsupporting

confidence: 77%

“…Our preliminary study found an incidence rate of 3.14% [12], which was as low as previous studies. Anastomotic strictures have previously been observed at a median of 5-12 months following colorectal surgery [3,13]. In the present study, anastomotic strictures occurred at a median of 7 months from the index surgery.…”

Section: Discussionsupporting

confidence: 55%

“…Studies haves shown that 3-30% of patients develop benign anastomotic strictures following colorectal surgery [2,3]. Our preliminary study found an incidence rate of 3.14% [12], which was as low as previous studies.…”

Section: Discussioncontrasting

confidence: 38%

“…The occurrence of benign anastomotic strictures after colorectal surgery is not uncommon [1] with studies showing an incidence rate of 3-30% [2,3]. Possible causes for such a condition include several factors, such as radiation, anastomotic ischemic changes, anastomotic leakage, and anastomotic technique [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

et al. 2020

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Background Postoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon. Methods A retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005-December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed. Results There were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33-84 years). The median follow-up period was 56 months (interquartile range 22.5-99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis. Conclusions Endoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 55%

Section: Discussioncontrasting

confidence: 38%

Section: Introductionmentioning

confidence: 99%

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Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

et al. 2020

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“…The initial success rate of balloon dilatation of postsurgical strictures is 91-100%, depending on the series [7,9]. Long-term follow-up studies show its effectiveness is maintained, avoiding the need for surgery in 75% of strictures [9,10], with a low rate of complications, around 15%, mostly minor (such as mild bleeding) that can generally be managed conservatively. A recent review of 850 procedures [11] estimated the overall rate of perforation with this technique at 1.1%.…”

Section: Dilatationmentioning

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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Anastomotic Complications

Friel

Kin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Mechanical bowel prep and oral antibiotics prior to colon resection are associated with a lower risk of anastomotic leak.• A significant proportion of anastomotic leaks present after the immediate postoperative period, especially if there is a history of pelvic radiation. • Most early anastomotic bleeds are self-limited; late bleeds may be a sign of anastomotic leak. • Anastomotic stricture after cancer resection should undergo endoscopic biopsy and imaging to rule out recurrent cancer. • Benign anastomotic strictures may be amenable to endoscopic management, but some will require surgical revision or completion proctectomy with permanent colostomy if the strictured anastomosis is in the pelvis. • Anastomotic complications often lead to significant detriments to quality of life with regard to pain, defecatory function, sexual function, and urinary function. Discussion of these issues with patients is critical for surgical decision-making. Anastomotic LeakThe unfortunate reality faced by every surgeon who performs bowel resections is the occurrence of anastomotic leaks. The incidence of anastomotic leak after bowel anastomosis ranges from 2% to 21% and is associated with significant risk of short-and long-term morbidity [1][2][3][4][5]. This complication can be a devastating event that sets off a cascade of other unfortunate events, resulting in significant det-riments to quality of life, increased pain, prolonged disability, and sometimes death. Anastomotic leaks are associated with significantly higher healthcare resource utilization and cost, as patients with this complication are more likely to require additional diagnostic tests, procedures or reoperations, hospital days, outpatient care, and readmissions [6,7]. Perhaps the most frustrating aspect of anastomotic leaks in colorectal surgery is the fact that leaks and their severe consequences still occur despite the adoption of evidence-based perioperative guidelines, efforts to optimize patient risk factors, and adherence to surgical principles. Although important progress has been made toward reducing the risk of anastomotic leak, there is still much work to be done to increase our understanding of the pathophysiology of anastomotic leak, and effective strategies for prevention.

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Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis

Abstract: Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection.

Cited by 32 publications

References 15 publications

Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

Anastomotic Complications

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