LAUSR

ANASTOMOTIC STENOSIS AFTER colorectal surgery is a common postsurgical complication with an incidence ranging from 3%–30%. Severe anastomotic stenosis is treated with endoscopic balloon dilation (EBD), radial incision and cutting (RIC), or surgery. Complete anastomotic stenosis (CAS) is considered rare but has been described in certain patients. EBD and RIC for this condition are technically difficult because of the inability to observe the oral-side lumen. Recently, a method of blunt dilation with a balloon technique through the guidewire after confirming the oral-side lumen by water-soluble contrast using an injection needle has been reported. However, blunt dilation was thought to be difficult when the stenosis is thick and hard due to postoperative fibrosis. We therefore developed and attempted a combination method using an injection needle to identify the oral-side lumen and a samelength tip of a needle knife for incision in a case of CAS with thickening and hardening. An 84-year-old man with rectal cancer underwent low anterior resection and ileostomy. Several months later, CAS was detected with endoscopy (Figure 1). The center of the stenosis was punctured with an injection needle, and water-soluble solution was injected through the needle. The oral-side lumen was identified via water-soluble contrast. The puncture point was penetrated and incised with a needle knife. The guidewire was passed through the hole, and EBD was subsequently performed (Video S1). EBD was performed the next day (Figure 2) and thereafter four times in 2 weeks.