Retrograde Endoscopic Treatment of Completely Obstructed Anastomotic Stricture After Anterior Resection

ABSTRACT BACKGROUND Biliary complications remain one of the most important causes of morbidity and graft loss after liver transplant (LT). Endoscopic therapy of biliary complications has proven to be effective over time, leaving surgical treatment restricted to only very few cases. However, we cannot yet predict which patients will have the greatest potential to benefit from endoscopic treatment. OBJECTIVE On this premise we decide to conduct this study to evaluate the role and safety of single operator cholangioscopy (SOC) in the endoscopic treatment of post-LT biliary anastomotic strictures (AS). METHODS: Between March/2016 and June/2017, 20 consecutive patients referred for endoscopic treatment for biliary anastomotic stricture were included in this prospective observational cohort study. Inclusion criteria were age over 18 years old, and a deceased LT performed within at least 30 days. Exclusion criteria were non-anastomotic biliary stricture, biliary leakage, cast syndrome, any previous endoscopic therapy, pregnancy and inability to provide informed consent. All patients underwent SOC before endoscopic therapy with fully covered self-expandable metal stent (FCSEMS) and after stent removal. RESULTS: At pre-treatment SOC, stricture orifice and fibrotic changes could be visualized in all patients, vascular changes and surgical sutures in 60% and acute inflammatory changes in 30%. SOC was essential for guidewire placement in five cases. FCSEMS was successfully deployed in all patients. Stricture resolution rate was 44.4% (median stent indwelling 372 days). Stricture recurrence was 12.5% (median follow-up of 543 days). Adverse events were distal (66.6%) and proximal (5.5%) stent migration, stent occlusion (16.6%), severe abdominal pain (10%) and mild acute pancreatitis (10%). SOC was repeated after FCSEMS removal. Post-treatment SOC showed fibrotic changes in all but one patient; vascular and acute inflammatory changes were less frequent in comparison to index procedure. The disappearance of suture material was remarkable. None of the cholangioscopic findings were statistically correlated to treatment outcome or stricture recurrence. CONCLUSION: Endoscopic retrograde cholangiography with SOC is feasible in post-LT patients with AS. Cholangioscopic findings can be classified into fibrotic, vascular and acute inflammatory changes. Cholangioscopy may be helpful to assist guidewire passage, but Its overall role for changing management is post-LT patients was not demonstrated.

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Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: a prospective comparison study of two balloon types

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(04)01813-9 ◽

2004 ◽

Vol 60 (3) ◽

pp. 347-350 ◽

Cited By ~ 42

Author(s):

Pietro Di Giorgio ◽

Leonardo De Luca ◽

Giuseppe Rivellini ◽

Enrico Sorrentino ◽

Emilia D'Amore ◽

...

Keyword(s):

Anterior Resection ◽

Low Anterior Resection ◽

Anastomotic Stricture ◽

Comparison Study ◽

Endoscopic Dilation ◽

Prospective Comparison

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Endoscopic Treatment of Vesicoileal Anastomotic Stricture

Journal of Laparoendoscopic Surgery ◽

10.1089/lps.1994.4.355 ◽

1994 ◽

Vol 4 (5) ◽

pp. 355-357

Author(s):

NABIL K. BISSADA

Keyword(s):

Endoscopic Treatment ◽

Anastomotic Stricture

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DOZ047.73: Endoscopic treatment of esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.73 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

T Vogiatzoglou ◽

S Arrigo ◽

P Gandullia

Keyword(s):

Esophageal Atresia ◽

Endoscopic Treatment ◽

Anastomotic Stricture ◽

Symptom Relief ◽

Balloon Catheter ◽

Therapeutic Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Anastomotic Strictures ◽

Tertiary Center ◽

Therapeutic Alternatives

Abstract Aim of the Study The aim of this study was to provide an overview of endoscopic treatment in children after reconstruction of esophageal atresia. Methods This study, conducted at a single tertiary center, reviewed patients requiring endoscopic treatment during a 15-year period, from 2004 to 2018. Collected data include number, frequency, complications, and effectiveness of esophageal anastomotic dilations. Results A total of 55 children with esophageal atresia (EA) underwent upper gastrointestinal endoscopy. Of those, 37 required therapeutic endoscopy with dilation procedures for anastomotic strictures. Thirty-five patients underwent dilations using only through-the-scope (TTS) balloon (BD),1 patient using only a Savary bougie (SB), and 1 using both. A total of 126 dilations were performed using BD in 36 patients and 6 dilations using SB in 2 patients. Specifically, in children treated only with BD were performed 1 dilation in 6 children (17.1%), 2 in 6 children (17.1%), 3 in 7 children (20%), 4 in 6 children (17.1%), 5 in 6 children (17.1%), 7 in 2 children (5.7%), and 8 in 2 children (5.7%). Balloon catheter sizes ranged from 6 mm to 15 mm. In 2 patients (5.4%) stents were placed, 1 and 6 stents, respectively. Intralesional triamcinolone was injected in 8 patients (21.6%) as additional therapy. Major complications included perforation in 4 patients (10,8%), resolved with conservative treatment. All patients had clinical improvement in the follow-up. Conclusion Currently, endoscopic treatment for esophageal anastomotic stricture is the first procedure adopted in clinical practice after the surgical approach, since it is regarded safe and effective. Balloon dilations are preferred in our overview as a treatment option for esophageal anastomotic strictures. Symptom relief is reported in all cases, while the rate of complications is very low. Sometimes, refractory strictures influence the patient's quality of life and therapeutic alternatives such as stent placement should be considered.

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