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CC BY 4.0 · Endoscopy 2023; 55(S 01): E1010-E1011
DOI: 10.1055/a-2127-4810
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Complete anastomotic stenosis treated by combined stricturotomy using two colonoscopes

Jiancong Hu 
1   Department of Endoscopy, Yuexi Hospital of the Sixth Affiliated Hospital, Sun Yat-sen University, Xinyi, Guangdong, P. R. China
2   Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
3   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
,
Qinghua Zhong
2   Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
3   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
,
Dezheng Lin
2   Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
3   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
,
Mingli Su
2   Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
3   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
,
Xuefeng Guo
2   Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
3   Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
› Author Affiliations
Supported by: National Key Clinical Discipline 1010PY(2020)-63
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Patients with postoperative benign anastomotic stricture after treatment for colorectal cancer can be treated successfully by endoscopic stricturotomy [1] [2]. However, the treatment of complete anastomotic stenosis is difficult due to the absence of the intestinal canal. Here, we present a case of complete anastomotic stenosis treated by combined stricturotomy with two colonoscopes.

A 61-year-old man with a history of radical resection of rectal cancer and transverse colostomy 1 year previously was admitted to our hospital. Colonoscopy showed complete stenosis of the colorectal anastomosis ([Fig. 1]). Using the distal colonic passage of the transverse colostomy, a combined stricturotomy using two colonoscopes was performed. One colonoscope (CF-H290I, Olympus) reached the oral side of the anastomosis from the transverse colostomy, while another colonoscope (PCF Q260 J, Olympus) observed from the anal side of the anastomosis. Each colonoscope was able to observe the light of the other colonoscope in the middle of the anastomotic scar. Through the oral-side colonoscope, a needle (VDK-IN, Vedkang) was inserted into the middle of the scar. The needle tip was visible from the anal side, and a circumferential incision was performed using a Hook Knife (KD620Q, Olympus), guided by the needle. After the incision, the anastomosis was recanalized, allowing the anal-side colonoscope to pass through the anastomosis into the oral-side colon ([Fig. 2], [Video 1]). Colonography showed that the anastomosis was unobstructed and there was no leakage ([Fig. 3]). The patient underwent colostomy closure 5 days after the stricturotomy and was discharged without any complications.

Zoom Image
Fig. 1 Colonoscopy showed complete stenosis of the colorectal anastomosis.
Zoom Image
Fig. 2 Recanalization procedure. a Each colonoscope was able to observe the light of the other colonoscope. b Circumferential incision was performed, guided by the needle. c The anastomosis was recanalized.

Video 1 Complete anastomotic stenosis treated by combined stricturotomy using two colonoscopes.


Quality:
Zoom Image
Fig. 3 Colonography showed the anastomosis to be unobstructed.

Combined stricturotomy using two colonoscopes provides a new approach to the management of complete anastomotic stenosis.

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Competing interests

The authors declare that they have no conflict of interest.

Acknowledgment

The authors would like to thank Dr. Chujun Li for providing advice on the treatment.

  • References

  • 1 Lin D, Liu W, Chen Z. et al. Endoscopic stricturotomy for patients with postoperative benign anastomotic stricture for colorectal cancer. Dis Colon Rectum 2022; 65: 590-598
    CrossrefPubMedSearch in Google Scholar
  • 2 Zhang L-J, Lan N, Wu X-R. et al. Endoscopic stricturotomy in the treatment of anastomotic strictures in inflammatory bowel disease (IBD) and non-IBD patients. Gastroenterol Rep (Oxf) 2020; 8: 143-150
    CrossrefPubMedSearch in Google Scholar

Corresponding author

Xuefeng Guo, MD, PhD
Department of Endoscopic Surgery
The Sixth Affiliated Hospital
Sun Yat-sen University
26 Yuancun Erheng Road
Guangzhou 510655
Guangdong
P. R. China   

Publication History

Article published online:
30 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Lin D, Liu W, Chen Z. et al. Endoscopic stricturotomy for patients with postoperative benign anastomotic stricture for colorectal cancer. Dis Colon Rectum 2022; 65: 590-598
    CrossrefPubMedSearch in Google Scholar
  • 2 Zhang L-J, Lan N, Wu X-R. et al. Endoscopic stricturotomy in the treatment of anastomotic strictures in inflammatory bowel disease (IBD) and non-IBD patients. Gastroenterol Rep (Oxf) 2020; 8: 143-150
    CrossrefPubMedSearch in Google Scholar

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Zoom Image
Fig. 1 Colonoscopy showed complete stenosis of the colorectal anastomosis.
Zoom Image
Fig. 2 Recanalization procedure. a Each colonoscope was able to observe the light of the other colonoscope. b Circumferential incision was performed, guided by the needle. c The anastomosis was recanalized.
Zoom Image
Fig. 3 Colonography showed the anastomosis to be unobstructed.