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Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope
Mark A De Lusong1, Janak N Shah, Roy Soetikno
1Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA.
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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