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COLONIC STRICTURE ETIOLOGY IS A USEFUL PROGNOSTIC FACTOR PREDICTING LONG TERM SUCCESSFUL OUTCOME FOLLOWING DILATION OF COLONIC ANASTOMOTIC STRICTURES
U Beejay, A Ribeiro, G de la Mora, L Hourigan, GB Haber, GP Kandel, P Kortan, NE Marcon
Centre for Therapeutic Endoscopy and Endoscopic Oncology, St Michael’s Hospital, University of Toronto, Toronto, Ontario
BACKGROUND: Colonic anastomotic strictures (CAS) are a frequent problem occurring in 2–5% of patients following colo-rectal surgery. Despite this prevalence, little is known about long term outcome parameters.
AIM: To identify any differences in long term clinical outcome of CAS undergoing dilatation.
METHODS: Single institution, retrospective case review of all CAS undergoing dilation completed over 36 months.
PATIENTS: A total of 39 patients (22M/17F, mean age 56 (range 19-76)) were identified with CAS. Presenting symptoms were altered bowel habits in 70%(23/33), abdominal cramps in 62%(20/33), and bloating in 34%(11/33). Underlying diseases were diverticular disease (28%), malignancy (54%) and inflammatory bowel disease(IBD) (18%). 77% of dilatations were completed using RigiflexÔ dilators (Microvasive Endoscopy, Boston Scientific Corporation, Natick, MA, USA), 19% with SavaryÔ dilators (Bard Interventional Products, Billerica, MA, USA), and 4% with the CREÔ Wireguided dilator (Microvasive Endoscopy, Boston Scientific Corporation, Natick, MA, USA). The mean maximum dilation achieved was 20mm (range 15-25mm). A combination of techniques were used in 6% of cases.
RESULTS: The mean technical success achieved in dilatation of CAS was 91%. The three month symptom relief rate was 86%, 81% and 96% for IBD, cancer and diverticular CAS respectively. The 24 month symptom relief rate was 57%, 76% and 82% for IBD, cancer, and diverticular CAS respectively. One perforation occurred in the IBD group which was treated surgically.
CONCLUSION: Although there is a good correlation between immediate outcome (technical success) and 3 month outcome (symptom relief), distinct differences are noted in rates of symptom relief after 24 months depending on etiology of the stricture. The etiology of CAS may be a useful prognostic factor in judging long term efficacy of colonic dilatation.