Epithelium-preserving stricturotomy is effective for improving postoperative benign anastomotic stricture associated with colorectal surgery

TL;DR

This study shows that preserving the intestinal epithelium during stricturotomy improves long-term outcomes for patients with postoperative benign anastomotic strictures after colorectal surgery.

Contribution

The study identifies epithelium preservation and stricture length as novel independent risk factors for stricture recurrence after endoscopic stricturotomy.

Findings

94.1% of patients achieved technical success after the first endoscopic stricturotomy.

17.5% of initially successful patients experienced stricture recurrence.

Preserving the intestinal epithelium and shorter stricture length reduced the risk of recurrence.

Abstract

We analyzed a large sample of patients with colorectal cancer (CRC) treated with endoscopic stricturotomy (ESt) for postoperative benign anastomotic stricture (POBAS) and explored risk factors for stricture recurrence (restricture). We aimed to provide data on the long-term outcomes of ESt and support for optimizing ESt in treating and preventing POBAS recurrence.

This retrospective study included 152 consecutive patients with CRC diagnosed with POBAS and treated by ESt at our center from April 2013 to April 2023. The primary outcome was stricture recurrence. Secondary outcomes were the technical success rate, postoperative adverse events (AEs), and restricture-free survival (RFS). Risk factors for stricture recurrence were explored.

Of the 152 patients, 94.1% (143/152) achieved technical success after the first ESt.
Twenty-two patients (17.5%) were diagnosed with recurrent stricture among 126 initial
successful patients with follow-up. Anastomotic stricture length ≥ 1 cm and non-preservation
of intestinal epithelium during ESt were independent risk factors for recurrence (
P
< 0.05). The cumulative RFS rate was 82.53%.

Anastomotic stricture length ≥ 1 cm and non-epithelium preservatoin at ESt were independent risk factors for restricture after ESt in POBAS patients. These two factors may help predict risk of POBAS recurrence and provide reliable evidence for developing personalized treatment plans for patients.

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