Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope and facilitated by SpyGlass (with videos) - 23/08/11
Reprint requests: Janak N. Shah, MD, California Pacific Medical Center, Interventional Endoscopy Services, 2351 Clay Street, Suite 124, San Francisco, CA 94115.San Francisco, California, USA
Abstract |
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.
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Vol 68 - N° 5
P. 988-992 - novembre 2008 Retour au numéro
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