{"title":"大肠吻合口狭窄的替代方法:套管扩张术","authors":"A. K. Taşkın","doi":"10.58600/eurjther1920","DOIUrl":null,"url":null,"abstract":"Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is <5 mm and length >1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely","PeriodicalId":42642,"journal":{"name":"European Journal of Therapeutics","volume":"378 ","pages":""},"PeriodicalIF":0.3000,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation\",\"authors\":\"A. K. Taşkın\",\"doi\":\"10.58600/eurjther1920\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is <5 mm and length >1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely\",\"PeriodicalId\":42642,\"journal\":{\"name\":\"European Journal of Therapeutics\",\"volume\":\"378 \",\"pages\":\"\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2023-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Therapeutics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.58600/eurjther1920\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Therapeutics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.58600/eurjther1920","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
亲爱的编辑,2-30%的结直肠手术后患者会出现吻合口狭窄(AS)。其发病机制有多种因素,如组织缺血、吻合口漏和放疗等[1,2]。强直性脊柱炎可采用内窥镜方法(球囊扩张术、球囊扩张术、支架、内窥镜电切术)、数字扩张术、外科手术方法(订书机狭窄成形术、经肛门环形订书机切除术、经腹重新吻合术)和皮质类固醇[3,4]。一般来说,完全/接近完全强直性脊柱炎患者首选手术治疗[1]。支架;肿瘤手术后使用支架治疗强直性脊柱炎的益处尚未得到证实[3]。不过,Philip BC Pangg 等人采用结肠/直肠内镜超声(EUS)吻合技术和热腔金属支架,非手术治疗了近完全性强直性脊柱炎[5]。我们对吻合口近乎完全狭窄的患者采用了三段式套管扩张术。一位 59 岁的女性患者因乙状结肠肿瘤接受了腹腔镜前切除术,随访时主诉腹部肿胀、间歇性腹痛和排便困难。一个月后,在进行结肠镜检查时,发现吻合口几乎完全狭窄。在导丝引导下,使用马洛尼柔性套管扩张器进行了套管扩张术。小口扩张术共进行了 3 次,每次间隔 15 天。第一次(33、36 和 42 F)和第二次(36、42 F)扩张后,通过胃镜检查可以看到吻合口狭窄的上段。第三次使用扩张器(42、45 F)扩张后,结肠镜很容易通过吻合口线到达上段。六个月后进行结肠镜检查,吻合口的近端部分在没有使用扩张器的情况下也很容易通过。球囊扩张是强直性脊柱炎患者首先使用的方法。不过,要想手术成功,必须重复几次。此外,当狭窄直径达到 1 厘米时,穿孔的风险就会增加。与套管扩张术相比,强直性脊柱炎的成功几率较低。如果球囊扩张失败,建议采用内窥镜电切术。数字扩张术:用于远端肛门直肠肛门狭窄。皮质类固醇应用:尚无大型研究。强直性脊柱炎的套管扩张术可提供触觉反馈,从而估计扩张器通过的阻力,避免穿孔。扩张器扩张法操作简单、费用低廉、并发症风险低。尤其是马洛尼柔性硅胶扩张器,可将并发症的风险降至最低。套管扩张器可以保持多年完好无损,可以重复使用。但球囊扩张器不能重复使用。在内窥镜方法失败的情况下,3-4%(完全/接近完全 AS)的患者会采用手术方法。但死亡率很高[1,4-6]。因此,可以采用 Philip BC Pang 等人的替代方法[5]。然而,由于内镜超声检查(EUS)中心有限,在吻合口狭窄的情况下,可以使用可弯曲的扩张器进行逐步扩张。您真诚的
Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation
Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is <5 mm and length >1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely