Endoscopic alternatives in managing anastomotic strictures of the colon and rectum

Abstract

Background

The development of anastomotic strictures following colorectal surgery is a frequent problem, but commonly used treatments (e.g. dilatation or revisional surgery) are often ineffective. This study assessed the efficacy of self–expanding metallic stents (SEMS) and endoscopic transanal resection of strictures (ETARS) in managing high–grade benign colorectal anastomotic strictures after the failure of first–line therapies.

Methods

All patients with biopsy–proven benign anastomotic strictures (luminal diameter <7 mm) following colorectal surgery, seen in the period April 1995–October 2004, were treated with either SEMS or ETARS.

Results

In the study period, we treated 10 patients (7 men) of median age 71 years. Ten ETARS procedures were performed in six patients, with a mean operating time of 42 minutes and a median hospital stay of 1 day. Early complications of ETARS included: re– operation for bleeding, asymptomatic anastomotic perforation and technical failure in an acutely angulated stricture. SEMS were successfully inserted into five patients (including two with failed ETARS) without any early complications. Overall, nine patients have had satisfactory longterm outcomes (median follow–up, 29 months; range, 3–75 months).

Conclusions

SEMS and ETARS are simple, safe and effective methods in treating high–grade anastomotic strictures.