The endoscopic management of benign short post-anastomotic ileocolonic stricture (PAICS) that is refractory to primary and secondary treatment modalities remains challenging. The lumen-apposing metal stent (LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy. LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents (FCSEMSs).

This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature. We report a life-saving technique not previously documented and the use of technology to improve patient outcomes. The six patients (median age, 75 years) suffered from vomiting, constipation and recurrent abdominal pain, with symptoms starting 23-25 wk post-surgery. The median stricture length was 1.83 cm. All six patients underwent successful and uneventful bi-flanged metal stent (BFMS)-LAMS placement for benign PAICS. All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal. According to the literature, the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding. Conversely, FCSEMS has a high migration rate (15%-50%).

The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options, allowing them to avoid more invasive surgical interventions. The BFMS (NAGI stent) is longer and larger than the prototype AXIOS-LAMS, which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.

• Bi-flanged metal stent
• Lumen-apposing metal stent
• Anastomotic ileocolonic stricture
• Self-expanding metal stent
• Endoscopic innovation
• Case report

• Endoscopic treatment
• Esophageal strictures
• Gastric outlet obstruction

• Constriction, Pathologic/therapy
• Dilatation
• Endoscopy
• Esophageal Stenosis/diagnostic imaging
• Esophageal Stenosis/etiology
• Esophageal Stenosis/surgery
• Humans
• Treatment Outcome

• adhesion
• endometriosis
• hernia
• large bowel obstruction
• retroperitoneal fibrosis
• stricture

Colonic ischemia is the most common form of gastrointestinal ischemia, which frequently affects the elderly population. The diagnosis and treatment can be challenging since it is prevalent in patients who are debilitated and have multiple comorbidities. However, most cases remain undetected until further complications emerge. Some of these patients will develop prolonged complications like chronic ischemic colitis or stricture requiring surgical intervention. Here we present a case of a colonic stricture secondary to recurrent ischemic colitis in an elderly female patient with multiple medical problems.

• abdominal pain
• anticoagulation
• colon ischemia
• hematochezia
• stricture

• Biopsy
• Colorectal cancer
• Colorectal stenting
• Endoscopy
• Guidelines
• Obstruction
• SEMS
• Self-expandable metallic stent

• Biopsy
• Colorectal Neoplasms/complications
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Prognosis
• Prospective Studies
• Retrospective Studies
• Self Expandable Metallic Stents
• Stents
• Treatment Outcome

• Anastomosis, Surgical/adverse effects
• Colorectal Neoplasms/surgery
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Rectum/surgery
• Retrospective Studies
• Stents
• Treatment Outcome

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

• Balloon dilatation
• Enteral stent
• Intestinal obstruction

• Anastomosis
• Colonoscopy
• Colorectal carcinoma
• Colorectal surgery
• Computed tomography (CT)
• Crohn’s disease
• Stricture

• Colorectal cancer
• bowel obstruction
• bridge to surgery
• colonoscopy
• emergency surgery
• endoscopy
• palliation
• self-expandable metal stent

• Benign colonic stenosis
• Compound Qingdai pill
• Self-expandable memory metallic stent

• Abdominal Pain/etiology
• Abdominal Pain/therapy
• Anti-Bacterial Agents/therapeutic use
• Biopsy
• Colectomy/methods
• Colon, Sigmoid/diagnostic imaging
• Colon, Sigmoid/drug effects
• Colon, Sigmoid/pathology
• Colon, Sigmoid/surgery
• Colonography, Computed Tomographic
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Constipation/etiology
• Constriction, Pathologic/chemically induced
• Constriction, Pathologic/complications
• Constriction, Pathologic/diagnosis
• Constriction, Pathologic/therapy
• Contrast Media/administration & dosage
• Diagnosis, Differential
• Diarrhea/diagnosis
• Diarrhea/etiology
• Diarrhea/microbiology
• Diatrizoate Meglumine/administration & dosage
• Dilatation/methods
• Drugs, Chinese Herbal/adverse effects
• Female
• Fluid Therapy
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Inflammatory Bowel Diseases/diagnosis
• Intestinal Obstruction/chemically induced
• Intestinal Obstruction/complications
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/therapy
• Laparoscopy/methods
• Levofloxacin/therapeutic use
• Middle Aged
• Pityriasis Rosea/drug therapy
• Self Expandable Metallic Stents

The prevalence of acute colorectal obstruction at the hospital setting is high. There is need for improvement in the quality of colonoscopy for relieving obstruction. A retrospective, uncontrolled, open-label study was conducted, with the aim of documenting the causes of acute colorectal obstruction and the quality of colonoscopy practice in managing obstruction at a university hospital in China. A total of 61 adult patients with acute colorectal obstruction treated with urgent colonoscopy between February, 2011 and January, 2016 were identified at the Endoscopic Unit of Tongji Hospital (Wuhan, China). The technique success rate was the primary outcome. The etiology was mainly related to malignant diseases, including colorectal cancer in 53 patients (86.9%) and advanced peritoneal serous carcinoma leading to extrinsic colonic compression in 1 patient (1.6%). Benign causes of obstruction included foreign bodies in 3 patients (4.9%) and fecal impaction in 2 patients (3.3%); furthermore, anastomotic strictures were found in 2 patients (3.3%). The technique success rate was 98.4% (60/61). All colorectal cancer patients who underwent urgent colonoscopy were admitted to the Department of Surgery for placement of a self-expanding metallic stent; 1 patient who had an extracolonic malignancy underwent placement of a transanal colonoscopic decompression tube as palliative therapy and 2 patients with anastomotic strictures underwent endoscopic balloon dilation. Furthermore, colonoscopy was used for extracting the foreign body, as well as removing fecal stones in all the patients. In conclusion, urgent colonoscopy as a minimal invasive approach is associated with certain advantages for diagnosing and managing acute colorectal obstruction. Furthermore, experienced operators achieved a better outcome when managing colorectal obstruction.

• acute colorectal obstruction
• endoscopic balloon dilation
• foreign body
• self-expanding metallic stent
• transanal colonoscopic decompression tube

• Adverse events
• Anesthesia
• Bleeding
• Complications
• Endoscopy
• Foreign body extraction
• Pediatrics
• Polypectomy
• Sedation
• Stenting

Iatrogenic anorectal stenosis is one of serious complications after anorectal surgery, and it is often caused by improper operation in surgical resection of hemorrhoids and anal fistula, procedure for prolapse and hemorrhoids (PPH), internal hemorrhoid agent injection and saving anal sphincter in low rectal cancer. Because of the difficulty of defecation, severe anal pain may occur. Stenotic ring can be directly touched in anal and low rectal stenosis. The degree and extent of the stenosis can be observed by colonoscopy in upper rectal stenosis. Mild stenosis can be temporarily treated with conservative therapy. If the degree of stenosis does not relieve or stenosis is more severe, we can choose different types of surgery according to the position, scope and the reasons of stenosis, which include scar closed procedure, longitudinal incision and transverse suture procedure, thread-drawing procedure, reconstruction of the anus by skin flap transposition or colostomy. Although only one procedure was adopted in the majority of cases, two or more procedures can be combined. This article reviews the diagnosis and treatment of anorectal stenosis.

• Iatrogenic anorectal stenosis
• Diagnosis
• Treatment