Efficacy and Safety of Endoscopic Balloon Dilation of Benign Anastomotic Strictures After Oncologic Anterior Rectal Resection

Abstract

Colorectal anastomotic benign strictures represent a challenging complication. Endoscopic dilation represents a valid and safe treatment. The purpose of this study is to retrospectively investigate the results of endoscopic balloon dilation for anastomotic stricture after anterior rectal resection for cancer in an institution. Twenty-four symptomatic patients with benign colorectal anastomotic stricture were treated between April 2001 and January 2005. All patients underwent dilation using through-the-scope balloon technique. The success of dilation, the number of sessions required, complications, recurrence, and the relationship between the number of dilation sessions and recurrence were assessed. Dilation was successful in 22 (91.7%) patients. There were no procedure-related complications. The mean number of sessions required was 2.3. There was no relationship between the number of dilation sessions and stricture recurrence. Through-the-scope dilation is effective and safe for benign colorectal anastomotic strictures after anterior resection. There was no relationship between the number of dilation sessions and recurrence.

Endoscopy-Guided Balloon Dilation of Benign Anastomotic Strictures after Radical Gastrectomy for Gastric Cancer

“…In that study, all dilations were effectively accomplished in ambulatory settings with no required hospital stay for 98% of the patients; a low rate of repeated dilations means reduced surgical costs for patients. TTS-BD is also effective and safe for benign colorectal anastomotic stricture, which occurs in approximately 20% of patients after low anterior resection 5,6. There was no relationship found between the number of dilation sessions and recurrence in those studies.…”

“…Balloon dilation (BD) has been shown to be a safe and effective nonsurgical method to manage anastomotic strictures. Endoscopically guided BD has been described in patients with esophageal anastomotic stricture,1–3 gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass,4 and colorectal anastomotic stricture 5,6. One study reported the management of benign anastomotic strictures after total gastrectomy by fluoroscopically guided BD without the use of an endoscope 7.…”

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

“…Treatment of all postsurgical strictures is recommended when they are symptomatic or when a diagnostic or therapeutic procedure proximal to the stricture is required. Special attention must be given to patients who have undergone surgery for a malignant colorectal cancer in order to be able to undertake an endoscopic follow-up due to the risk of metachronous cancer [7].…”

“…Since the first balloon dilatation of a benign rectal stricture in 1984, this technique has become the treatment of choice for this condition, especially when the stricture is postsurgical and related with inflammatory bowel disease [3,7].…”

“…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.…”