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DOI: 10.1055/s-0032-1325973
Endoscopic needle-knife treatment of refractory ileo–ascending anastomotic stricture
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Publication History
Publication Date:
22 March 2013 (online)
A 45-year-old man with Crohn’s disease diagnosed in 1988 who had undergone an ileocecal resection with an end-to-side anastomosis in 1995 presented with pain in the right lower abdomen. A colonoscopy was performed using an Olympus colonoscope (Tokyo, Japan), during which a noninflamed fibrotic stricture of the anastomosis that could not be passed by the endoscope was found ([Fig. 1]). Because the patient refused surgery, six balloon dilations of the stricture were performed at 3-monthly intervals. Unfortunately these resulted in limited improvement in both the degree of stenosis and the patient’s symptoms.
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In order to overcome the stricture, it was decided to incise the fibrotic bridge with a needle-knife papillotome (Zimmon needle-knife papillotome; Cook Medical Europe, Limerick, Ireland; [Fig. 2]). It was possible to make this incision safely because of a perfect view of the tissue bridge, the enteral loop, and the colonic loop in a parallel position. After the incision had been made, the endoscope was able to be passed beyond the anastomosis. Normal ileal mucosa was seen immediately beyond the anastomosis. At follow-up colonoscopy 3 months later, it was still possible to pass the endoscope beyond the anastomosis. During 7 months of follow-up, the patient has remained symptom free.
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Fibrotic strictures of the ileo–ascending anastomosis are common complications of Crohn’s disease after ileocecal resection [1]. Drug treatment is ineffective in the absence of active inflammation. To minimize the need for multiple resections, bowel-conserving strategies that include surgical stricturoplasty and endoscopic balloon dilation have been developed. The long-term success rate of endoscopic dilations is high (80 %) [2].
Only a few case series of endoscopic needle-knife incision have been published. These include needle-knife incision of upper gastrointestinal anastomotic strictures [3], anastomotic sinuses [4], and rectal anastomotic strictures [5]. To our knowledge, we present the first case of a successful needle-knife incision of an ileo–ascending anastomotic stricture in a patient with Crohn’s disease. Balloon dilation can sometimes be ineffective, especially in very rigid fibrotic strictures, and in these cases needle-knife incision might provide an alternative treatment to balloon dilation.
Endoscopy_UCTN_Code_TTT_1AQ_2AF
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Competing interests: None
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References
- 1 Rutgeerts P, Geboes K, Vantrappen G et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990; 99: 956-963
- 2 van Assche G, Thienpont C, D’Hoore A et al. Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut 2010; 59: 320-324
- 3 Hordijk ML, Siersema PD, Tilanus HW et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc 2006; 63: 157-163
- 4 Lian L, Geisler D, Shen B. Endoscopic needle knife treatment of chronic presacral sinus at the anastomosis at an ileal pouch–anal anastomosis. Endoscopy 2010; 42: 14
- 5 Truong S, Willis S, Schumpelick V. Endoscopic therapy of benign anastomotic strictures of the colorectum by electroincision and balloon dilatation. Endoscopy 1997; 29: 845-849
Corresponding author
-
References
- 1 Rutgeerts P, Geboes K, Vantrappen G et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990; 99: 956-963
- 2 van Assche G, Thienpont C, D’Hoore A et al. Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut 2010; 59: 320-324
- 3 Hordijk ML, Siersema PD, Tilanus HW et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc 2006; 63: 157-163
- 4 Lian L, Geisler D, Shen B. Endoscopic needle knife treatment of chronic presacral sinus at the anastomosis at an ileal pouch–anal anastomosis. Endoscopy 2010; 42: 14
- 5 Truong S, Willis S, Schumpelick V. Endoscopic therapy of benign anastomotic strictures of the colorectum by electroincision and balloon dilatation. Endoscopy 1997; 29: 845-849
![](https://www.thieme-connect.de/media/endoscopy/2013S02/thumbnails/10-1055-s-0032-1325973-i404cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2013S02/thumbnails/10-1055-s-0032-1325973-i404cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)