Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope and facilitated by SpyGlass (with videos)

Background: Colonic anastomotic strictures complicate colorectal resection in up to 7% of cases and are often managed with endoscopic dilation. Complete anastomotic obstructions are rare and have traditionally required surgical remediation. Objective: To demonstrate a novel endoscopic approach to treat complete colonic anastomotic obstruction. Design: Case report. Setting: Tertiary-referral center. Patient: A 40-year-old woman with a completely obstructed colonic anastomosis after sigmoidectomy for a fibrotic Crohn's stricture. Interventions: A prototype front-view and forward-array echoendoscope was used to recanalize the completely obstructed anastomotic stricture. Real-time EUS imaging guided puncture through the stenosis. Access into the proximal obstructed segment was confirmed by using SpyGlass fiberoptic probe visualization. Subsequent stricture dilation was performed by using wire-guided balloon dilators through the instrument channel of the prototype echoendoscope, and luminal continuity was reestablished. Main Outcome Measurements: Technique success and complications. Results: The completely obstructed anastomotic stricture was successfully recanalized and dilated by using a single, prototype, forward-array echoendoscope without complications. Limitations: Single case report with a relatively short follow-up interval. Conclusions: EUS-guided puncture and dilation of completely obstructed anastomotic strictures is feasible when using a prototype forward-array echoendoscope. This novel technique appears to be an effective method to reestablish luminal continuity across completely obstructed strictures.