Endscopic therapy of postoperative intestinal strictures

Aim: To analyse efficacy and safety of endoscopic therapy of postoperative intestinal strictures. Methods: In a retrospective analysis, the outcome of endoscopic balloon dilatation in nine patients with upper (2) or lower (7) gastrointestinal postoperative strictures has been reviewed. Surgery resulting in strictures included gastric resection (1), pancreatic head resection (1), ileocecal resections for Crohn's disease (2), and colorectal resections (5). Patients with oesophageal or biliary tract strictures have not been reviewed. Results: Primary endoscopic balloon dilatation was successful in all nine patients. A dilatation for acute obstruction was effective to resolve acute intestinal obstruction (ileus) in all three patients. Subsequent surgical reconstruction of intestinal patency has been electively performed in two of three patients with such ileus (time to surgery after dilation: 2 and 5 weeks). Subsequent to the primary dilatation procedure, a self-expanding enteral metal stent was inserted in two other patients to maintain intestinal patency. Permanent solution of the strictures has been achieved in the other five patients with repeated endoscopic dilations (2 to 3 sections of dilatations in each patient). No major complications (perforation, bleeding, and/or septic complication) were observed after the procedures. Conclusion: Endoscopic dilation with or without subsequent stenting is an effective and safe method to manage postoperative intestinal strictures.