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[Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases]
Karine Delaunay-Tardy1, Claude Barthélémy, Olivier Dumas
1Service de Gastroentérologie et d'Hépatologie, C.H.U. de Saint-Etienne, Hôpital Nord, 42055 Saint-Etienne Cedex 2. karineetseb@wanadoo.fr
Unlabelled:
Benign postoperative anastomotic strictures are frequent.
Objectives:
To evaluate the results of endoscopic dilatations and to propose an alternative treatment to surgery.
Methods:
Between 1994 and 2001, 27 patients (16 female, 11 male, median 70 years old) with colonic anastomotic strictures were treated with pneumatic or mechanical dilatation. Eleven patients (40.7%) had been operated on for colon carcinoma, 2 for colorectal adenoma and 14 (51.8%) for complicated diverticular disease. A left colectomy was performed in 12 patients and a sigmoid colectomy in 15. Anastomoses were stapled in 25 cases.
Results:
Twenty one patients were symptomatic (78%). The median time to diagnosis after surgery was 3 months (range: 21 days-4 years). Dilatation was possible in 26 cases (96.3%). The total number of dilatation sessions was 51 and the median number of sessions by patient was 2 (range: 1-4). Only one session was done in 11 patients (40.7%). There was one case of bowel perforation (1.9%) with the guide wire. In 21 cases (77.7%), the patients were no longer symptomatic and failure was observed in 5 cases. Surgery was necessary for 3 patients, with stenosis recurrence in 1. Three patients were treated with a self expanding metal stent.
Conclusion:
Endoscopic dilatation is a simple and efficient method. Therefore, it might be considered as the first line approach for benign anastomotic strictures. Self expanding metal stent could be an alternative to surgery, in case of failure.