Fabio Shiguehissa Kawaguti, MD, from the Cancer Institute, São Paulo University Medical School, in São Paulo, Brazil share this VideoGIE case, “Endoscopic radial incision and cutting procedure for a colorectal anastomotic stricture.”
We present a patient with rectal cancer that was treated by surgical resection and temporary ileostomy and presented colorectal anastomotic stricture at the colonoscopy before the colonic transit reconstruction. Balloon dilatation wasn’t performed in this case. Our video presents a new therapeutic option using IT-knife to cut and resect the fibrotic tissue of the stricture (RIC procedure). Radial incisions are performed in the stricture and the fibrotic tissue between the incisions is resected, using the IT knife, which usually is used to perform resection of early esophageal and gastric cancer by endoscopic submucosal dissection (ESD).
This technique was initially described by Muto M et al for treatment of upper GI tract refractory strictures (Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture. Gastrointest Endosc 2012;75:965-72) and recently Osera S et al published a case series using RIC technique for treatment of refractory colorectal anastomotic strictures (Efficacy and safety of RIC for benign severe anastomotic stricture after surgery for lower rectal cancer. Gastrointest Endosc 2015;81:770-73). Both studies presented good outcomes. Our case wasn’t a refractory stricture and it was necessary only one therapeutic procedure to treat it.
Colorectal anastomotic strictures are usually treated with balloon dilatation, however not rare cases of restenosis. The RIC procedure can be a new therapeutic option for treatment of strictures, refractory or not.
This case presents an alternative use to the IT-knife, a device originally created to perform resection of early esophageal and gastric cancers by ESD technique.
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