Endoscopic management of complete colorectal anastomotic occlusion: Where do we stand?

Abstract

We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology. In this article, the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes, one for radial electrical incision and the other serving as a guide light. However, this technique can be applied only in selected cases. Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction, by reviewing the available literature, we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.

Keywords: Colorectal anastomotic occlusion; Transillumination; Rendez-vous endoscopic technique; Anastomotic stricture; Recanalization; Stricturotomy

Core Tip: The management of complete anastomotic occlusion following colorectal surgery is challenging. Despite advances in surgical techniques, surgical revision is associated with significant morbidity and mortality. Therapeutic endoscopy has been introduced as a minimally invasive approach for the management of this postoperative complication with promising results. Based on the article by Chi et al, we reviewed all available endoscopic techniques that have been used for the recanalization of completely obstructed anastomoses, highlighting the pivotal role that endoscopy can play in the management of this postoperative complication.