Recanalization of a complete colorectal anastomotic stenosis: an application of the Hot AXIOS stent

A 43-year-old woman underwent emergency surgery for a neoplastic colonic perforation. A sigmoidectomy with colorectal anastomosis protected by an ileostomy was performed. Pathological findings showed a well differentiated pt4N1aM0 adenocarcinoma. FOLFOX adjuvant chemotherapy was given. At endoscopy, 3 months later, a complete anastomotic stenosis was detected ([Fig. 1]). After discussion with the surgical team, it was decided to proceed with endoscopic management using a lumen-apposing metal stent (LAMS), as described in previous cases[1] [2].

Fig. 1 Endoscopic image showing complete obstruction of the colorectal anastomosis.

A therapeutic linear echoendoscope (EG-580UT; Fujifilm, Tokyo, Japan) was positioned in the rectum. After the suprastenotic colon had been identified with the echoendoscope, a 19G needle (Boston Scientific Corp.) was inserted into the center of the stenosis. Opacification under fluoroscopic control confirmed the correct positioning of the needle and allowed the upstream colon to be filled. A 0.035-inch guidewire (Jagwire; Boston Scientific Corp.) was inserted into the left colon. A 15 × 10-mm cautery-enhanced LAMS (Hot AXIOS; Boston Scientific Corp.) was deployed using pure cutting current, without any complications ([Fig. 2] and [Fig. 3]). The stent was removed 1 month later with a grasper, leaving a large anastomosis. There was no recurrence of the stenosis on endoscopic follow-ups at 1 month ([Fig. 4]) and 1 year ([Video 1]).

Fig. 2 Endoscopic ultrasound image showing the distal anchor flange of the lumen-apposing metal stent being released.

Fig. 3 Endoscopic image showing the successfully deployed lumen-apposing metal stent.

Fig. 4 Image during a follow-up endoscopy 1 month after the lumen-apposing metal stent had been removed showing recanalization of the colon.

Video 1 Recanalization of a complete colorectal anastomotic stenosis using a cautery-enhanced lumen-apposing metal stent.

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This case demonstrates that a LAMS is also useful in postoperative benign strictures and may avoid the need for surgery.

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• References

• 1 Gornals JB, Albines G, Trenti L. et al. EUS-guided recanalization of a complete rectal anastomotic stenosis by use of a lumen-apposing metal stent. Gastrointest Endosc 2015; 82: 752
• 2 Nunes G, Marques PP, Patita M. et al. EUS-guided recanalization of complete colorectal anastomotic stenosis using a lumen-apposing metal stent. Endosc Ultrasound 2019; 8: 211-212