Annual Scientific Meeting
Introduction: Fecal diversion has been used as a protective measure for newly constructed intestinal anastomoses or to settle chronic refractory inflammation. Fecal diversion had been associated with complications such as diversion-related anal stricture. The aim of this study is to exam the significance and the endoscopic treatment for diversion-related stricture.
Methods: All consecutive patients with diversion-associated anal stricture that were treated with endoscopic stricturotomy (ESt) in our interventional IBD center (i-IBD) were extracted from patient medical charts from 2010 to 2018. The primary outcome was surgery-free survival.
Results: A total of 33 patients underwent ESt for their diversion associated strictures. Patients were mostly Caucasian (N=27, 81.8%) and 18 patients (54.5%) were female. Most of the patients included in this study were diagnosed with ulcerative colitis (N=22, 66.7%) and most underwent ileal pouch-anal anastomosis (IPAA) with J configuration (N=24, 72.7%). The most prevalent reason for diversion included anastomotic leaks/sinus/fistula (N=11, 33.3%), refractory pouchitis (N=8, 24.2%) and stricturing disease (N=8, 24.2%). Patients were diagnosed with their stricture at the average age of 43.9±16.1 years. The length of the stricture treated was 2.7±2.2cm and 32 (97.0%) strictures were nontraversable to endoscope. These patients underwent 2.5±1.9 sessions of ESt in a follow-up of 2.2±1.5 years. Symptomatic improvement was seen in 15/25 (60.0) patients. Subsequent surgery was needed in 4 (12.1%) and 10 (30.3%) had their stoma reversed. No post-ESt complication was reported.
Discussion: ESt is an effective safe way of treating diversion-related anal strictures. More than half of patients experienced symptomatic improvement and a third of patients had their stoma reversed successfully.