Lee Taek-Gu, Yoon Soon Man, Lee Sang-Jeon
Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea.
Department of Internal medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea.
World J Gastrointest Surg. 2020 Nov 27;12(11):460-467. doi: 10.4240/wjgs.v12.i11.460.
Anastomotic stenosis (AS) after colorectal surgery was treated with balloon dilation, endoscopic procedure or surgery. The endoscopic procedures including dilation, electrocautery incision, or radial incision and cutting (RIC) were preferred because of lower complication rates than surgery and are less invasive. Endoscopic RIC has a greater success rate than dilation methods. Most reports showed that repeated RICs were needed to maintain patency of the anastomosis. We report that single session RIC was applied only to treatment-naive patients with AS.
Two female patients presented with AS. One patient had advanced rectal cancer and the other had a refractory stenosis following surgery for endometriosis at sigmoid colon. The endoscopic RIC procedure was performed as follows. A single small incision was carefully made to increase the view of the proximal colon and the incision was expanded until the surgical stapling line. Finally, we made a further circumferential excision with endoscopic knife along the inner border of the surgical staple line. At the end of the procedure, the standard colonoscope was able to pass freely through the widened opening. All patients showed improved AS after a single session of RIC without immediate or delayed procedure-related complications. Follow-up colonoscopy at 7 and 8 mo after endoscopic RIC revealed intact anastomotic sites in both patients. No treatment-related adverse events or recurrence of the stenosis was demonstrated during follow-up periods of 20 and 23 mo.
The endoscopic RIC may play a role as one of treatment options for treatment-naive AS with short stenotic lengths.
结直肠手术后的吻合口狭窄（AS）可通过球囊扩张、内镜手术或外科手术治疗。内镜手术包括扩张、电灼切开或放射状切开与切除（RIC），因其并发症发生率低于外科手术且侵入性较小而更受青睐。内镜RIC的成功率高于扩张方法。大多数报告显示，需要重复进行RIC以维持吻合口通畅。我们报告单次RIC仅应用于未接受过治疗的AS患者。
两名女性患者出现AS。一名患者患有晚期直肠癌，另一名患者在乙状结肠子宫内膜异位症手术后出现难治性狭窄。内镜RIC手术如下进行。小心地做一个小切口以增加近端结肠的视野，并将切口扩大直至手术吻合线。最后，我们用内镜刀沿手术吻合线的内缘进行进一步的环形切除。手术结束时，标准结肠镜能够自由通过扩大的开口。所有患者在单次RIC后AS均得到改善，且无立即或延迟的手术相关并发症。内镜RIC后7个月和8个月的随访结肠镜检查显示两名患者的吻合口部位均完整。在20个月和23个月的随访期间未发现与治疗相关的不良事件或狭窄复发。
内镜RIC可能作为未接受过治疗、狭窄长度较短的AS的治疗选择之一发挥作用。
