Doppler ultrasound-guided endoscopic needle-knife treatment of an anastomotic stricture following subtotal colectomy
Year: 2011
Type: article
Study design: Case Report
Abstract: A 28-year-old woman presented to our clinic with a 2-month history of dyschezia after subtotal colectomy and ileorectal anastomosis (IRA). Sigmoidoscopy showed a 5-mm long, nonulcerated IRA stricture ([ Fig. 1 a ]), which was not traversable with a GIF-H180 gastroscope (Olympus, Tokyo, Japan). Fig. 1 Ileorectal anastomotic stricture: a before and b after Doppler ultrasound-guided needle-knife therapy. The patient did not have sustained symptom improvement after endoscopic balloon dilation, and it was decided to treat the refractory anastomotic stricture with endoscopic needle-knife therapy, carried out by an experienced endoscopist (BS). A disposable single-use Doppler ultrasound probe (VTI Vascular Technology, Nashua, New Hampshire, USA) was introduced through the working channel of a GIF-H180 gastroscope to map the stricture areas with no large-volume blood flow ([ Video 1 ]). Quality: mobile 360 480 720 Download Video 1 Use of a Doppler ultrasound probe to guide endoscopic needle-knife therapy. Then electroincision was carried out with an Olympus triple-lumen needle-knife catheter (Olympus Medical Systems, Tokyo, Japan) ([ Fig. 1 b ], [ Video 1 ]). The procedure took 10 minutes and was uneventful, and 24 hours later the patient had significant symptom improvement. A follow-up sigmoidoscopy was accomplished without difficulty in intubating the anastomosis 3 months later. A small recurrent stricture at the IRA was further treated using the same method ([ Fig. 2 a, b ]). Fig. 2 Small recurrent anastomotic stricture 3 months after treatment: a before and b after further Doppler ultrasound-guided needle-knife treatment. Anastomotic strictures complicate colorectal surgery in 3 – 30 % of all cases [ 1 ]. Endoscopic balloon dilation remains the preferred first-line treatment for benign anastomotic strictures due to its safety and feasibility [ 2 ], but long-term results appeared to be poor [ 3 ]. While there have been a few case reports of endoscopic needle-knife electroincision of upper gastrointestinal anastomotic strictures [ 4 ] and anastomotic leaks/sinuses [ 5 ], use of the technique has not been reported for stricture treatment in the lower gastrointestinal tract. In addition, electroincision as reported was carried out in a “blind” fashion and not with Doppler ultrasound guidance. To our knowledge, this is the first case report of the use of Doppler ultrasound in endoscopic needle-knife treatment of anastomotic strictures. The procedure appears to be simple, safe, and feasible for treating benign anastomotic strictures. Endoscopy_UCTN_Code_TTT_1AQ_2AF
Source: Endoscopy
Institutions: Peking Union Medical College Hospital, Cleveland Clinic
Language: English
Topic: Esophageal and GI Pathology
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2319030884