Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis

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Abstract
Background Despite standardized techniques, anastomotic complications after colorectal resection remain a challenging problem. Among those, anastomotic stricture is a debilitating outcome which often requires multiple interventions and which is prone to recur. The present series investigates the long-term results of endoscopic balloon dilation for stenotic colorectal anastomosis. Methods Consecutive patients from a single institution who presented with an anastomotic stenosis after a colorectal resection were identified using a prospective clinical database. Medical records were systematically reviewed to detail patients’ outcomes. Results Over 17 years (1988–2015), 2361 consecutive patients underwent a colorectal anastomosis. Of those, 76 patients (3.2 %) suffered a symptomatic anastomotic stenosis within a median of 5 months (interquartile range (IQR) 2–13) of the index procedure. All stenoses were primarily treated by endoscopic balloon dilation. Median follow-up was 11 years (IQR 7–14). In half the patients, one to two attempts at endoscopic balloon dilation definitively relieved the stenosis. Overall, the median number of endoscopic balloon dilation required was 3 (IQR 2–3). Recurrence rates at 1 year, 3 year, and 5 year were 11, 22, and 25 %, respectively. Median time to recurrence was 12 months (IQR 3–24). Ultimately, two patients (2.6 %) underwent an operation due to failure of endoscopic treatment. All other patients (97.4 %) were treated successfully with endoscopic balloon dilation. A total of 12 patients (15.7 %) suffered a complication from endoscopic dilation. Of those, 11 were minor bleeding and one was a perforation at the level of the anastomosis. All complications were managed conservatively, and no emergency procedure was required as a consequence of attempted endoscopic balloon dilation. Conclusion Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection.

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