Endoscopic treatment of postoperative colorectal anastomotic strictures

Abstract

High success and low complication rates make endoscopic dilatation the treatment of choice to avoid high-risk reoperations in patients with benign anastomotic stricture. The presence of stapler anastomosis, postoperative leakage, and/or radiotherapy does not significantly impede successful endoscopic dilatation.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…168 One study included dilation of malignant strictures and encountered no haemorrhagic complication in 94 cases (68 malignant and 26 anastomotic strictures). 169 In a RCT of pneumatic dilatation versus laparoscopic myotomy for achalasia there were no reported haemorrhages but 8/108 (9.5%) patients experienced perforation during the treatment course. 170 None of the abovementioned studies was primarily designed to evaluate the risk of bleeding associated with dilation.…”

Balloon Dilatation of Benign Rectal Anastomotic Strictures – A Review

“…The mean number of patients recruited per year was thus 4.30, and the mean number of procedures per year was thus 9.04. Only one study gave an overall incidence of stricture after rectal surgery of 7.34% (26/422) [15]. A second study looked specifically at patients who underwent laparoscopic sigmoid colectomy and found the incidence to be 17.6% (12/68) [4].…”

“…This involved insertion of a double balloon catheter under fluoroscopic guidance and dilating the two balloons (outer 20 mm and inner 10, 15, or 20 mm diameter). Suchan et al [15] used either fluoroscopic or endoscopic dilatation of stricture in 82% (78/94) patients. Of these, 30 patients also underwent laser/argon incision if the diameter of the stricture was <7 mm in order to facilitate insertion of the hydrostatic balloon catheter.…”

Transanal Treatment of Strictured Rectal Anastomosis with a Circular Stapler Device: Simple and Safe

“…An ongoing debate exists about the treatment modality of choice for colorectal strictures. Among the different minimally invasive therapeutic treatment options such as transanal dilatation (manual or by bougie), microwave coagulation therapy, transanal incision and argon plasma coagulation, transanal balloon dilatation has been recommended as the preferred treatment option [5]. However, transanal balloon dilatation has only a reported success rate of about 60% in patients having undergone cancer surgery with an overall complication rate of about 17% [5].…”

“…Among the different minimally invasive therapeutic treatment options such as transanal dilatation (manual or by bougie), microwave coagulation therapy, transanal incision and argon plasma coagulation, transanal balloon dilatation has been recommended as the preferred treatment option [5]. However, transanal balloon dilatation has only a reported success rate of about 60% in patients having undergone cancer surgery with an overall complication rate of about 17% [5]. Among very few case reports about new innovative treatment modalities with circular staplers for severe colorectal strictures, transanal reanastomosis by means of a circular stapler is reported to be easy and effective [6, 7].…”