Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2020; 12(11): 460-467
Published online Nov 27, 2020. doi: 10.4240/wjgs.v12.i11.460
Endoscopic radial incision and cutting technique for treatment-naive stricture of colorectal anastomosis: Two case reports
Taek-Gu Lee, Soon Man Yoon, Sang-Jeon Lee
Taek-Gu Lee, Sang-Jeon Lee, Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Soon Man Yoon, Department of Internal medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Author contributions: Lee TG, Yoon SM performed the diagnostic investigations and treatments, reviewed the literature and contributed to manuscript drafting; Lee SJ was the patient’s surgeon; Yoon SM was responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soon Man Yoon, MD, PhD, Associate Professor, Department of Internal medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju-si 28644, Chungcheongbuk-do, South Korea. smyoon@chungbuk.ac.kr
Received: July 30, 2020
Peer-review started: July 30, 2020
First decision: September 17, 2020
Revised: September 30, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: November 27, 2020
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

The endoscopic RIC may play a role as one of treatment options for treatment-naive AS with short stenotic lengths.

Keywords: Colorectal surgery, Anastomosis, Stenosis, Endoscopy, Radial incision, Case report

Core Tip: Currently, most clinicians prefer endoscopic procedures for the treatment of stenosis after colorectal anastomoses, including dilation, electrocautery incision, or radial incision and cutting (RIC), because they have lower complication rates than surgery and are less invasive. Here, we report the use of endoscopic RIC alone with single session for two patients who presented with treatment-naive anastomotic stenosis (AS) after colorectal anastomosis. The endoscopic RIC procedure may play a role as one of the treatment options for treatment-naive, central-type AS with short stenotic lengths and for AS confined to the mucosa and submucosa.