title: Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Endoscopic balloon dilation is a safe approach to effectively relieve an anastomotic stenosis following a colorectal resection.
authors.affiliation: Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Biraima
authors.affiliation: Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Adamina
authors.affiliation: Department of Gastroenterology and Hepatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
authors.forename: Res
authors.initials: R
authors.lastname: Jost
authors.affiliation: Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
authors.affiliation: Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. christopher.soll@ksw.ch.
authors.forename: Christopher
authors.initials: C
authors.lastname: Soll
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000601:surgery; D004106:Dilatation / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Anastomosis; Balloon dilation; Colorectal; Stenosis