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Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses

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Abstract

Background

Endoscopic balloon dilation is the first-line treatment for benign colorectal anastomotic strictures. We aimed to objectively assess its long-term results.

Methods

Gastrointestinal symptoms and health-related quality of life (HRQoL) were assessed at long-term after balloon dilation of anastomotic strictures in 31 consecutive patients (excluding those with inflammatory bowel disease) as well as and controls, using the validated Gastrointestinal Quality of Life Index (GIQLI). Most colectomies had been performed for benign diseases, with anastomoses located at the colorectal junction.

Results

Completed surveys were collected from 81 subjects, including 27 study patients (response rate 87%), 27 surgical controls matched for age, gender, and indication of colectomy, and 27 healthy subjects. At a mean of 3.9 ± 2.3 years after the first endoscopic balloon-dilation, study patients self-reported significantly more gastrointestinal symptoms than controls; these included frequent and urgent bowel movements, bloating, food restriction (p ≤ 0.001, all comparisons), diarrhea, excessive passage of gas through the anus (p < 0.01, all comparisons), constipation, and abdominal pain (p < 0.05, all comparisons). Health-related quality of life was significantly impaired in study patients versus surgical controls and healthy subjects (GIQLI scores, 104 ± 20, 119 ± 24, and 121 ± 16, respectively; p = 0.005). Impaired HRQoL subdimensions included gastrointestinal symptoms (p < 0.001), stress by treatment (p < 0.05), and emotional status (p = 0.08). HRQoL was independent of the delay between stricture dilation and the survey. Follow-up endoscopy (performed in 21/27 [78%] study patients, including the 7 patients with the lowest HRQoL, and 19 [70%] surgical controls) disclosed anastomoses larger than 13 mm in all cases.

Conclusions

Health-related quality of life is significantly impaired at long-term after standard balloon-dilation of benign anastomotic colorectal strictures as a result of gastrointestinal symptoms and stress by treatment. This impairment might be related to the fact that an anastomotic diameter ≥13 mm, although commonly used to define successful endoscopic treatment, is insufficient to provide long-term symptom relief in some patients, or to other, yet to be identified, factors.

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References

  1. Addolorato G, Capristo E, Stefanini GF, Gasbarrini G (1997) Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol 32:1013–1021

    Article  PubMed  CAS  Google Scholar 

  2. Cotton PB (1994) Outcomes of endoscopy procedures: struggling towards definitions. Gastrointest Endosc 40:514–518

    Article  PubMed  CAS  Google Scholar 

  3. Di Giorgio P, De Luca L, Rivellini G, Sorrentino E, D’Amore E, De Luca B (2004) Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: A prospective comparison study of two balloon types. Gastrointest Endosc 60:347–350

    Article  PubMed  Google Scholar 

  4. Di ZH, Shin JH, Kim JH, Song HY (2005) Colorectal anastomotic strictures: treatment by fluoroscopic double balloon dilation. J Vasc Interv Radiol 16:75–80

    PubMed  Google Scholar 

  5. Dziki AJ, Duncan MD, Harmon JW, Saini N, Malthaner RA, Trad KS, Fernicola MT, Hakki F, Ugarte RM (1991) Advantages of handsewn over stapled bowel anastomosis. Dis Colon Rectum 34:442–448

    Article  PubMed  CAS  Google Scholar 

  6. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  PubMed  CAS  Google Scholar 

  7. Garcea G, Sutton CD, Lloyd TD, Jameson J, Scott A, Kelly MJ (2003) Management of benign rectal strictures: a review of present therapeutic procedures. Dis Colon Rectum 46:1451–1460

    Article  PubMed  CAS  Google Scholar 

  8. Hagiwara A, Sakakura C, Shirasu M, Torii T, Hirata Y, Yamagishi H (1999) Sigmoidofiberscopic incision plus balloon dilatation for anastomotic cicatricial stricture after anterior resection of the rectum. World J Surg 23:717–720

    Article  PubMed  CAS  Google Scholar 

  9. Johansson C (1996) Endoscopic dilation of rectal strictures: a prospective study of 18 cases. Dis Colon Rectum 39:423–428

    Article  PubMed  CAS  Google Scholar 

  10. Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat B, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18:879–897

    Article  PubMed  CAS  Google Scholar 

  11. Luchtefeld MA, Milsom JW, Senagore A, Surrell JA, Mazier WP (1989) Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership. Dis Colon Rectum 32:733–736

    Article  PubMed  CAS  Google Scholar 

  12. Lustosa SA, Matos D, Atallah AN, Castro AA (2001) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev: CD003144

    Google Scholar 

  13. MacRae HM, McLeod RS (1998) Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 41:180–189

    Article  PubMed  CAS  Google Scholar 

  14. Quintana JM, Arostegui I, Oribe V, Lopez de Tejada I, Barrios B, Garay I (2005) Influence of age and gender on quality-of-life outcomes after cholecystectomy. Qual Life Res 14:815–825

    Article  PubMed  CAS  Google Scholar 

  15. Quintana JM, Cabriada J, Lopez de Tejada I, Varona M, Oribe V, Barrios B, Perdigo L, Bilbao A (2001) Translation and validation of the gastrointestinal Quality of Life Index (GIQLI). Rev Esp Enferm Dig 93:693–706

    PubMed  CAS  Google Scholar 

  16. Reinshagen K, Muldner A, Reinshagen S, Kahler G (2005) Endoscopically controlled strictureplasty for stenotic colorectal anastomosis. Endoscopy 37:873–875

    Article  PubMed  CAS  Google Scholar 

  17. Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44:1464–1468

    Article  PubMed  CAS  Google Scholar 

  18. Schubert D, Kuhn R, Lippert H, Pross M (2003) Endoscopic treatment of benign gastrointestinal anastomotic strictures using argon plasma coagulation in combination with diathermy. Surg Endosc 17:1579–1582

    Article  PubMed  CAS  Google Scholar 

  19. Schwenk W, Neudecker J, Haase O, Raue W, Strohm T, Muller JM (2004) Comparison of EORTC quality of life core questionnaire (EORTC-QLQ-C30) and gastrointestinal quality of life index (GIQLI) in patients undergoing elective colorectal cancer resection. Int J Colorectal Dis 19:554–560

    Article  PubMed  CAS  Google Scholar 

  20. Skreden K, Wiig JN, Myrvold HE (1987) Balloon dilation of rectal strictures. Acta Chir Scand 153:615–617

    PubMed  CAS  Google Scholar 

  21. Slim K, Bousquet J, Kwiatkowski F, Lescure G, Pezet D, Chipponi J (1999) [First validation of the French version of the Gastrointestinal Quality of Life Index (GIQLI)]. Gastroenterol Clin Biol 23:25–31

    PubMed  CAS  Google Scholar 

  22. Suchan KL, Muldner A, Manegold BC (2003) Endoscopic treatment of postoperative colorectal anastomotic strictures. Surg Endosc 17:1110–1113

    Article  PubMed  CAS  Google Scholar 

  23. Truong S, Willis S, Schumpelick V (1997) Endoscopic therapy of benign anastomotic strictures of the colorectum by electroincision and balloon dilatation. Endoscopy 29:845–849

    PubMed  CAS  Google Scholar 

  24. Venkatesh KS, Ramanujam PS, McGee S (1992) Hydrostatic balloon dilatation of benign colonic anastomotic strictures. Dis Colon Rectum 35:789–791

    Article  PubMed  CAS  Google Scholar 

  25. Virgilio C, Cosentino S, Favara C, Russo V, Russo A (1995) Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy 27:219–222

    Article  PubMed  CAS  Google Scholar 

  26. Yeung SM, Shiu AT, Martin CR, Chu KM (2006) Translation and validation of the Chinese version of the Gastrointestinal Quality of Life Index in patients with gastric tumor. J Psychosom Res 61:469–477

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest, 24, 1205, Geneva, Switzerland

    T. Nguyen-Tang & J. M. Dumonceau

  2. Service of Digestive Surgery, Geneva University Hospitals, Micheli-du-Crest, 24, 1205, Geneva, Switzerland

    O. Huber & P. Gervaz

Authors
  1. T. Nguyen-Tang
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  2. O. Huber
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  3. P. Gervaz
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  4. J. M. Dumonceau
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Correspondence to J. M. Dumonceau.

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Nguyen-Tang, T., Huber, O., Gervaz, P. et al. Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses. Surg Endosc 22, 1660–1666 (2008). https://doi.org/10.1007/s00464-007-9679-9

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  • DOI: https://doi.org/10.1007/s00464-007-9679-9

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