Bravi Ivana, Ravizza Davide, Fiori Giancarla, Tamayo Darina, Trovato Cristina, De Roberto Giuseppe, Genco Chiara, Crosta Cristiano
Division of Endoscopy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
Surg Endosc. 2016 Jan;30(1):229-32. doi: 10.1007/s00464-015-4191-0. Epub 2015 Apr 3.
Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures.
Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up.
The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation.
Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.
良性结肠吻合口狭窄有时发生于手术后，通常需要手术或内镜扩张治疗。在多个非对照研究系列中，已证实使用球囊或探条式扩张器进行内镜下结肠吻合口狭窄扩张是安全有效的。然而，关于内镜电灼扩张的安全性和有效性的数据较少。我们研究的目的是回顾性调查内镜电灼扩张治疗术后良性结肠吻合口狭窄的安全性和有效性。
纳入2001年6月至2013年2月间接受内镜电灼扩张治疗的60例良性结肠或直肠吻合口狭窄患者（37例女性；中位年龄63.6岁，范围22.6 - 81.7岁）。吻合口狭窄定义为标准结肠镜无法通过的狭窄吻合口。仅环形吻合口狭窄被认为适合电灼扩张，该扩张由使用预切开括约肌切开刀进行的放射状切口组成。如果扩张后标准结肠镜能够通过结肠吻合口，则认为治疗成功。复发定义为随访期间吻合口狭窄再次出现。
结直肠手术与首次内镜评估或症状出现之间的时间间隔为7.3个月（1.3 - 60.7）。所有患者电灼扩张均成功。无手术相关并发症。中位随访时间为35.5个月（2.0 - 144.0）。3例经电灼扩张和Savary扩张成功治疗的患者出现吻合口狭窄复发。
内镜电灼扩张是治疗环形良性结肠术后吻合口狭窄的一种安全有效的方法。
