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Risk factors for the failure of endoscopic balloon dilation to manage anastomotic stricture from colorectal surgery: retrospective cohort study

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Abstract

Background

An anastomotic stricture after colorectal surgery is principally managed by endoscopic balloon dilation (EBD). Although this intervention is effective, however, subsequent procedures or surgical interventions are often required. This study aimed to assess the long-term outcomes of EBD for anastomotic stricture arising from colorectal cancer surgery.

Materials and methods

We analyzed 173 patients who received curative surgery for colorectal cancer at our hospital between January 2000 and December 2022 and had undergone EBD to manage anastomotic stricture. The medical records of these cases were retrospectively reviewed to assess the outcomes and risk factors for restenosis and permanent stoma.

Results

Of the 173 study patients, 41 (23.7%) presented with restenosis with a median time to recurrence of 49 [37–150] days. The restenosis group was significantly younger (55.6 years versus 60.8 years), with a more prominent rectal location (80.5% versus 57.6%), a higher incidence of hand-sewn anastomosis (24.4% versus 5.3%), and a higher percentage of neoadjuvant radiotherapy (34.1% versus 5.3%, P < 0.001). Multivariable analysis indicated neoadjuvant radiotherapy (adjusted HR 2.48; 95% CI 1.03–5.95) and cerebral vascular disease (adjusted HR 6.97; 95% CI 2.15–22.54) as independent prognostic factors for restenosis. Fourteen patients (8.1%) required a permanent stoma due to treatment failure. All cases needing a permanent stoma were male (14 patients, 100%, P = 0.007) and this group had a higher rate of neoadjuvant radiotherapy, adjuvant chemotherapy, and hand-sewn anastomosis.

Conclusion

Patients receiving neoadjuvant radiotherapy are most prone to restenosis after an EBD intervention to manage an anastomotic stricture. Neoadjuvant radiotherapy is also a strong risk factor for requiring a permanent stomas due to treatment failure.

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Funding

This study was supported by the National R&D Program for Cancer Control through the National Cancer Center (NCC) funded by the Ministry of Health & Welfare, Republic of Korea (HA22C0042).

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Author notes

  1. Young Il Kim and Seung Wook Hong have equally contributed to this study as first authors.

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Young Il Kim, Seok-Byung Lim, Eon Bin Kim, Min Hyun Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park & Chang Sik Yu

  2. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Seung Wook Hong & Dong-Hoon Yang

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  1. Young Il Kim
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Correspondence to Seok-Byung Lim.

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Dr. Young Il Kim, Seung Wook Hong, Seok-Byung Lim, Dong-Hoon Yang, Eon Bin Kim, Min Hyun Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, and Chang Sik Yu have no conflicts of interest or financial ties to disclose.

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Kim, Y.I., Hong, S.W., Lim, SB. et al. Risk factors for the failure of endoscopic balloon dilation to manage anastomotic stricture from colorectal surgery: retrospective cohort study. Surg Endosc 38, 1775–1783 (2024). https://doi.org/10.1007/s00464-023-10661-2

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