A 22-year-old woman with a history of familial colonic polyposis underwent surgery in 2009; she underwent total colectomy and ileorectal lateroterminal anastomosis with mechanical suture of the 25-gauge anal margin remaining at 12 cm.
Seven months after the operation, the patient presented anastomotic stricture, beginning with the usual treatment with balloon dilatation of those who did not have it. At the beginning, the stenosis is not permeable to the endoscope.
This technique has been described as having reached 18 mm, although revisions had been implemented due to the precautionality of recurrences.
We propose the possibility of performing radial electro-incisions in this anastomosis through endoscopy with needle sphincterotomy and assisted by balloon dilatations.
To decide on this technique, we let ourselves be influenced by the situation of the anastomosis, the previous experience in the treatment of nasogastric stenosis is also not considered due to esophageal stenosis and the absence of management risks of prosthesis and metal expandable neoplasia.
The technique was successfully performed, it was decided to make 6 little deep "star" incisions (which entails little risk of perforation) about 3 mm. After the incisions, only the same caliber was observed when the balloon was inserted.
Finally, 40 mg of triamcinolone was introduced, going from 9 mm to 20 mm in the same session.
The needle sphincterotome we use is the model RX Needle Knife XL 5.5 F and 5 mm long needle (Boston Scientific®).
The diathermy source is the ERBE ICC 200 model, endocut current, effect 3 and power 60 W.
After 1 year of incisional therapy the caliber has not decreased in the controls that have been performed.
