Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Jain, Deepanshu; Sandhu, Naemat; Singhal, Shashideep

doi:10.20524/aog.2017.0163

Cited by 19 publications

(25 citation statements)

References 24 publications

(121 reference statements)

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“…To some extent, it is an anticipated complication Complications Events/Total Figure 6 Complications rate. because it occurs in up to 22% of the cases with colorectal anastomosis even in the absence of a leak [41]. The lack of colonic transit after ileostomy may also play a role.…”

Section: Discussionmentioning

confidence: 99%

Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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Aim The aim of the present work was to perform an up‐to‐date review of the literature on endoluminal negative pressure therapy for colorectal anastomotic leak. Method An electronic search in PubMed and Google Scholar and a manual search without language restrictions were performed on 25 January 2019. Only original series reporting endoluminal negative pressure therapy in colorectal anastomotic leaks were included. The primary outcome was the success rate (complete closure of the abscess cavity). The secondary outcomes were the rates of complications and stoma closure. Results Nineteen series with a total of 295 cases were analysed. The median distance of the anastomosis from the anal verge and the size of the abscess were 5.65 cm (4.9–10) and 6.0 cm (5–8.1) respectively. In 84.5% (78%–91%) the stoma was created at the first intervention. Neoadjuvant therapy was performed in 48.6% (3%–60%). Median 7 sponges (2–34) were used with median negative pressure 150 mmHg (125–700) for a median of 31 days (14–127). The success rate was 85.4% (80%–91%) with ileostomy closure in 72.6%. Complications were observed in 19% (13%–25%): abscesses 11.5% and anastomotic stenosis 4.4%. Laparotomy was required in 15% of the complications. The stoma was the only significant predictor for the success of the therapy (0.007, SE 0.004, P = 0.040). Conclusions The initial experience looks promising with an 85% success rate, which precludes risky re‐resections with redo anastomosis or Hartmann's procedure. Despite the good initial results, definitive conclusions cannot be drawn because of the small sample size and the lack of high‐quality comparative studies.

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Section: Discussionmentioning

confidence: 99%

Endoluminal negative pressure therapy in colorectal anastomotic leaks

et al. 2019

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“…In 2017, a meta-analysis [33] of 10 studies involving a total of 186 patients treated with this technique, either alone or in combination with other techniques, found clinical success in Of note is the greater recurrence when incisions are combined with balloon dilatation. This could be explained by the fact that the dilatation increases the trauma to the stricture, with the corresponding inflammatory changes and retraction.…”

Section: The Following Figures Show the Various Steps Of The Techniqumentioning

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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“…Benign gastrointestinal (GI) strictures can arise anywhere in the lumen of GI tract as a result of various etiologies. Endoscopic management is the mainstay of therapy and management options currently include endoscopic balloon dilation (EBD), intralesional steroid injection, incisional therapy, and fully covered self-expandable metal stents (SEMS) [1][2][3][4]. Although these treatment modalities are effective, stricture recurrence is not uncommon.…”

Section: Introductionmentioning

confidence: 99%

Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions

Larson¹

2019

aog

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The management of short-segment benign gastrointestinal (GI) strictures refractory to currently available endoscopic treatments (endoscopic balloon dilation, intralesional steroid injection, incisional therapy and fully covered self-expanding metal stents) proves to be challenging. Lumenapposing metal stents (LAMS), originally developed for access to and drainage of pancreatic fluid collections, are being used in an off-label manner for the treatment of short GI luminal strictures. The short length and wide flanges make LAMS potentially suitable for this indication and may reduce complications and improve patient tolerance. In this article we review the published literature, including 138 patients from 4 retrospective studies and 13 case reports who received a LAMS for the treatment of a short GI luminal stricture. In the reviewed literature only 2 of the 138 cases had immediate adverse events warranting hospitalization: perforation and postoperative GI bleed. A total adverse event rate of 32.5% (45 of 138 cases) was reported. Migration was the most common adverse event, accounting for 40% of the total. Nearly 58% of reported patients had symptom and stricture resolution after stent removal in the reviewed studies. Follow up varied from 28-352 days after stent removal. Although more data are needed to determine their long-term safety and efficacy, LAMS represent an important alternative to traditional endoscopic options when approaching patients with short GI luminal strictures.

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Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures

Cited by 19 publications

References 24 publications

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Endoluminal negative pressure therapy in colorectal anastomotic leaks

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions

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