A Modified "Rendezvous" Technique for EUS-guided Recanalization of a Rectal Anastomotic Stricture without Fluoroscopy and Stenting

Abstract

Various endoscopic techniques have been described for the treatment of post-operative colonic strictures. Our aim is to report a solely EUS-guided recanalization procedure for a complete rectal stricture, without the use of fluoroscopy or stenting. A 66-year-old male was submitted to low anterior resection and protective ileostomy for rectal adenocarcinoma, complicated with complete anastomotic stricture 6 months later. The patient was treated with a modified EUS-guided rendezvous technique. A colonoscope was advanced through the ileostomy to the sigmoid colon, which was subsequently filled with water. A linear echoendoscope was advanced transanally to the distal part of the rectal anastomosis. The proximal colon was punctured with a 19G needle and a guidewire was advanced through the needle. The rectocolonic fistula tract was first dilated by graduated dilation catheters. Subsequently, progressive pneumatic dilatation was performed. There were no post-procedural complications. At 6-month follow-up the anastomosis was patent, with no significant stricture recurrence. In conclusion, a rendezvous technique for EUS-guided recanalization of complete rectal anastomotic strictures is feasible and safe in a non-radiology assisted setting. In selected cases of distal stenoses balloon dilation could effectively serve as the sole treatment, without the adjunct of stent placement.