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DOI: 10.1055/a-1393-5165
Endoscopic incision and balloon dilation using the rendezvous technique for complete anastomotic obstruction after rectal low-anterior resection
Anastomotic stenosis, a major complication after low-anterior resection, can usually be treated by endoscopic balloon dilation [1] [2]. However, endoscopic management is challenging in the presence of a complete obstruction because an endoscope and other devices cannot be passed through the obstruction. Combined endoscopic incision and balloon dilation has reportedly been useful for treating complete rectal anastomotic obstruction [3]. If the patient has a stoma with double orifices, a simultaneous antegrade–retrograde approach to the obstructed anastomosis using two endoscopes may be feasible, a method known as the “rendezvous technique”[4].
A woman in her 60 s underwent laparoscopic rectal low-anterior resection and a diverting loop ileostomy after previous endoscopic submucosal dissection (ESD) for early rectal cancer. Stoma closure was scheduled to be performed 7 months post-surgery, but a colonoscopy performed for preoperative evaluation revealed complete obstruction of the rectal anastomosis ([Fig. 1]). Accordingly, endoscopic intervention was attempted for this obstruction.
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An endoscope (PCF-H290TI; Olympus Co., Tokyo, Japan) with a distal attachment (D-201-11804; Olympus) was passed through the distal loop ileostomy site until it reached the oral side of the obstruction site. Simultaneously, another endoscope (PCF-H290ZI; Olympus) with a distal attachment (D-201-13404; Olympus) was inserted transanally. Although contrast agent sprayed through the trans-stomal endoscope did not flow to the anorectal side ([Fig. 2]), transillumination from the trans-stomal endoscope could be seen across the septum ([Fig. 3]), suggesting the obstruction was membranous. The obstruction site was incised from the anal side using an electrosurgical endoknife (ISSEN; Kaneka Co., Tokyo, Japan) while the incision site was confirmed from the oral side using the rendezvous technique ([Fig. 4]). After a small aperture was created, a controlled radial expansion balloon (Boston Scientific, Marlborough, Massachusetts, USA) was inserted and endoscopic balloon dilation was performed. The obstruction was completely recanalized without adverse events ([Fig. 5]; [Video 1]).
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Video 1 The rendezvous technique is used to treat a complete anastomotic obstruction after rectal low-anterior resection, with the obstruction site being incised from the anal side, while being observed with a trans-stomal endoscope.
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Competing interests
Yoji Takeuchi received honoria from Olympus.
Acknowledgments
We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/ac), for editing a draft of this manuscript.
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References
- 1 Viriglio C, Consentino S, Favara C. et al. Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy 1995; 27: 219-222
- 2 Di Giorgio P, De Luca L, Rivellini G. et al. Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: a prospective comparison study of two balloon types. Gastrointest Endosc 2004; 60: 347-350
- 3 Yuan X, Liu W, Ye L. et al. Combination of endoscopic incision and balloon dilation for treatment of a completely obstructed anastomotic stenosis following colorectal resection: A case report. Medicine (Baltimore) 2019; 98: e16292
- 4 Kaushik N, Rubin J, McGrath K. Treatment of benign complete colonic anastomotic obstruction by using an endoscopic rendezvous technique. Gastrointest Endosc 2006; 63: 727-730
Corresponding author
Publikationsverlauf
Artikel online veröffentlicht:
15. März 2021
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References
- 1 Viriglio C, Consentino S, Favara C. et al. Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy 1995; 27: 219-222
- 2 Di Giorgio P, De Luca L, Rivellini G. et al. Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: a prospective comparison study of two balloon types. Gastrointest Endosc 2004; 60: 347-350
- 3 Yuan X, Liu W, Ye L. et al. Combination of endoscopic incision and balloon dilation for treatment of a completely obstructed anastomotic stenosis following colorectal resection: A case report. Medicine (Baltimore) 2019; 98: e16292
- 4 Kaushik N, Rubin J, McGrath K. Treatment of benign complete colonic anastomotic obstruction by using an endoscopic rendezvous technique. Gastrointest Endosc 2006; 63: 727-730
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