Therapeutic colonoscopy
Colonic stricture (anastomotic or Crohn’s stricture)
Balloon dilatation of these strictures is an option. It can avoid or postpone surgery.
- Strictures more than 5 cms in length should not be balloon dilated.
- Dilate only fibrotic strictures without ulcer.
- Dilate only if symptomatic.
- Malignant stricture- never dilate
Remember:
- One or more session may be needed. Alternatively, the stricture can be dilated once and if symptoms recur- they can be dilated again.
- The technical success rate, defined as achieving an endoscopically passable residual stricture, is between 70% and 90 %, independent of the balloon’s diameter.
- Complications such as haemorrhages are rare, while perforations are reported mostly in studies in which 25 mm balloons are used.
- It is difficult to define the relapse risk after endoscopic balloon dilatation, as the published studies are heterogenous. In a recent long-term study, stricture relapse rate was 46% after a mean of 32 months. (Stienecker K. Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: a prospective study. World J Gastroenterol.2009 Jun 7;15(21):2623-7)
Size of balloon
If the stenosis is > 5mm in diameter- use 18-20 mm balloon
If the stenosis is < 5mm in diameter- use 15 mm balloon
Pinhole stenosis- 12 mm balloon
Colorectal stent
Indications
- Palliative decompression of advanced disease
- Preoperative decompression- stent insertion avoids an emergency surgery with its benefit on morbidity and mortality
Types of Stent
- Through the scope stents- inserted under direct vision
- Inserted over a guidewire under fluoroscopic guidance
Complications
The major complications are stent migration (11 percent), perforation (4.5 percent), and reobstruction (12 percent).
