The radial incision and cutting method, in which the stricture is incised and the
scar tissue excised, has shown promising results in the treatment of refractory anastomotic
strictures [1]
[2]. It is useful for refractory strictures that are not adequately dilated after repeated
endoscopic balloon dilation.
Gel immersion endoscopy with clear gel (VISCOCLEAR; Otsuka Pharmaceuticals Factory,
Chiyoda, Japan) is used to displace blood and clots to ensure a good field of view
in situations with heavy bleeding or residue [3]
[4].
The patient was a 47-year-old man who underwent low anterior resection with creation
of a temporary colostomy for rectal cancer. However, a postoperative anastomotic stricture
was observed, and endoscopic balloon dilation was performed twice on an outpatient
basis after discharge. Because the stricture was refractory and resulted in difficulty
passing the scope despite the two dilations ([Fig. 1]), radial incision and cutting was performed ([Video 1]).
Fig. 1 The stricture was refractory and difficult for the scope to pass through despite
endoscopic balloon dilation.
Video 1 Radial incision and cutting under gel immersion for the treatment of refractory anastomotic
stenosis is safe and feasible.
An ITknife nano (KD-612; Olympus Corp., Tokyo, Japan) was inserted into the stricture,
and the scar was incised in the endo cut mode. The incision with the endo cut caused
a multifocal hemorrhage resulting in difficulty maintaining the field of view. When
the gel was used, the bleeding point became clear, and it was possible to make an
incision with a good field of view while recognizing the line of the muscle layer
even with heavy bleeding ([Fig. 2]). After the procedure, passage of the scope was possible, and no complications were
observed ([Fig. 3]). Endoscopy showed improvement of the stricture 2 weeks later ([Fig. 4]).
Fig. 2 It was possible to make an incision with a good field of view under gel immersion
endoscopy even in a situation with heavy bleeding.
Fig. 3 It was possible for the scope to pass through after radial incision and cutting.
Fig. 4 Endoscopy showed improvement of the stricture 2 weeks after the procedure.
Gel immersion endoscopy ensured a good field of view, even in situations with heavy
bleeding. Radial incision and cutting under gel immersion is a safe and efficient
method for the treatment of refractory colorectal anastomotic strictures.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AF
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