Successful endoscopic needle knife therapy combined with topical doxycycline injection of chronic sinus at ileal pouch-anal anastomosis

Abstract

Aim: Chronic presacral sinus at the anastomosis after restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been difficult to manage and results in a high rate of pouch failure. The aim was to present a novel technique with a combining endoscopic doxycycline injection and needle knife therapy for a sinus at the ileoanal anastomosis.

Methods: We applied repeat Doppler ultrasound-guided endoscopic needle knife therapy to open the orifice of the anastomotic sinus followed by topical injection of doxycycline.

Results: After six sessions of the endoscopic therapy, the refractory sinus was completely healed.

Conclusion: The Doppler ultrasound guided endoscopy therapy may provide an alternative treatment option for the patients with anastomotic sinus.