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. 2023 Aug;25(8):1708-1712.
doi: 10.1111/codi.16649. Epub 2023 Jul 11.

Endoscopic ultrasound-guided colo-colostomy for the treatment of benign complete occlusion of colonic anastomosis: a case series and description of technique

Philip B C Pang  1 , Ashvina Chouhan  2 , Heman M N Joshi  3 , James M D Wheeler  3 , Gareth D Corbett  1 , Sibu Varghese  1 , Edmund M Godfrey  2
Affiliations

Endoscopic ultrasound-guided colo-colostomy for the treatment of benign complete occlusion of colonic anastomosis: a case series and description of technique

Philip B C Pang et al. Colorectal Dis. 2023 Aug.

Abstract

Aim: The incidence of benign colonic anastomotic stricture is approximately 2% in patients undergoing left hemicolectomy or anterior resection and as high as 16% in patients undergoing low anterior or intersphincteric resection. In the majority, rather than complete occlusion, a stenosis forms, which can be managed with endoscopic balloon dilatation, a self-expanding metallic stent or endoscopic electroincision. In the less common scenario of a completely occluded colonic anastomosis, surgery is often required. In this study, we aim to describe the technique we used to treat this condition non-operatively METHOD: We describe a case series of three patients with benign complete occlusion of their colorectal anastomosis and how we managed them nonoperatively with a colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a Hot lumen-apposing metallic stent.

Results: We demonstrate that the technical and clinical success for this technique is 100%.

Conclusions: We believe that the technique we describe is effective and safe. It should be widely reproducible in centres with expertise in interventional EUS, given the similarity to well-established procedures such as EUS-guided gastroenterostomy. Patient selection and timing of reversal of ileostomy need careful consideration, especially in patients with a history of keloid formation. Given the shorter hospital stay and reduced invasiveness of this technique, we believe it should be considered for all patients who have complete benign occlusion of a colonic anastomosis. However, given the small number of cases and short period of follow-up, the long-term outcome of this technique is not known. More studies with higher power and a longer period of follow-up should be conducted to further ascertain the effectiveness of this technique.

Keywords: EUS-guided colo-colostomy; EUS-guided colonic anastomosis; benign colonic anastomotic stricture; benign completely occluded colonic anastomosis.

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References

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