BACKGROUND: Colonic anastomotic strictures complicate colorectal resection in up to 7% of cases and are often managed with endoscopic dilation. Complete anastomotic obstructions are rare and have traditionally required surgical remediation. OBJECTIVE: To demonstrate a novel endoscopic approach to treat complete colonic anastomotic obstruction. DESIGN: Case report. SETTING: Tertiary-referral center. PATIENT: A 40-year-old woman with a completely obstructed colonic anastomosis after sigmoidectomy for a fibrotic Crohn's stricture. INTERVENTIONS: A prototype front-view and forward-array echoendoscope was used to recanalize the completely obstructed anastomotic stricture. Real-time EUS imaging guided puncture through the stenosis. Access into the proximal obstructed segment was confirmed by using SpyGlass fiberoptic probe visualization. Subsequent stricture dilation was performed by using wire-guided balloon dilators through the instrument channel of the prototype echoendoscope, and luminal continuity was reestablished. MAIN OUTCOME MEASUREMENTS: Technique success and complications. RESULTS: The completely obstructed anastomotic stricture was successfully recanalized and dilated by using a single, prototype, forward-array echoendoscope without complications. LIMITATIONS: Single case report with a relatively short follow-up interval. CONCLUSIONS: EUS-guided puncture and dilation of completely obstructed anastomotic strictures is feasible when using a prototype forward-array echoendoscope. This novel technique appears to be an effective method to reestablish luminal continuity across completely obstructed strictures.
BACKGROUND:Colonic anastomotic strictures complicate colorectal resection in up to 7% of cases and are often managed with endoscopic dilation. Complete anastomotic obstructions are rare and have traditionally required surgical remediation. OBJECTIVE: To demonstrate a novel endoscopic approach to treat complete colonic anastomotic obstruction. DESIGN: Case report. SETTING: Tertiary-referral center. PATIENT: A 40-year-old woman with a completely obstructed colonic anastomosis after sigmoidectomy for a fibrotic Crohn's stricture. INTERVENTIONS: A prototype front-view and forward-array echoendoscope was used to recanalize the completely obstructed anastomotic stricture. Real-time EUS imaging guided puncture through the stenosis. Access into the proximal obstructed segment was confirmed by using SpyGlass fiberoptic probe visualization. Subsequent stricture dilation was performed by using wire-guided balloon dilators through the instrument channel of the prototype echoendoscope, and luminal continuity was reestablished. MAIN OUTCOME MEASUREMENTS: Technique success and complications. RESULTS: The completely obstructed anastomotic stricture was successfully recanalized and dilated by using a single, prototype, forward-array echoendoscope without complications. LIMITATIONS: Single case report with a relatively short follow-up interval. CONCLUSIONS: EUS-guided puncture and dilation of completely obstructed anastomotic strictures is feasible when using a prototype forward-array echoendoscope. This novel technique appears to be an effective method to reestablish luminal continuity across completely obstructed strictures.
Authors: Seung Uk Jeong; Hassanuddin Aizan; Tae Jun Song; Dong Wan Seo; Su-Hui Kim; Do Hyun Park; Sang Soo Lee; Sung Koo Lee; Myung-Hwan Kim Journal: World J Gastroenterol Date: 2013-11-07 Impact factor: 5.742
Authors: Irina Mihaela Cazacu; Adriana Alexandra Luzuriaga Chavez; Adrian Saftoiu; Peter Vilmann; Manoop S Bhutani Journal: Endosc Ultrasound Date: 2018 May-Jun Impact factor: 5.628