Endoscopy 2018; 50(06): 646-647
DOI: 10.1055/a-0591-2148
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Rendezvous recanalization of a postoperative coloanal anastomotic dehiscence with a lumen-apposing metal stent

Omid Sanaei
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
,
Olaya Brewer Gutierrez
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
,
Robert Moran
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
,
Juliana Yang
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
,
Mouen A. Khashab
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
› Author Affiliations
Further Information

Corresponding author

Mouen A. Khashab, MD
Johns Hopkins Hospital
1800 Orleans Street
Sheikh Zayed Tower
Baltimore, MD 21287
USA   
Phone: +1-443-287-1960   

Publication History

Publication Date:
09 April 2018 (eFirst)

 

LAMSs have been successfully used for the recanalization of complete colorectal anastomotic obstructions [1] [2]. However, there are no reports of using LAMSs in the treatment of coloanal anastomotic dehiscence.

A 51-year-old man with a rectosigmoid tumor underwent low anterior resection. His surgery was then complicated by leakage, which was treated by proctectomy, coloanal anastomosis, and creation of a diverting ileostomy. On follow-up sigmoidoscopy, the anastomosis appeared to have dehisced and no lumen to the proximal colon was identified. Therefore, a rendezvous approach was planned for the treatment of coloanal anastomotic dehiscence.

An upper gastrointestinal (GI) endoscope was advanced transanally to the coloanal anastomosis, while a pediatric colonoscope was advanced towards the anastomosis through the loop ileostomy ([Fig. 1]). With the use of fluoroscopic guidance and transillumination, the dehiscent coloanal anastomosis was identified. A guidewire was advanced in an antegrade direction and was captured from the anus. A 15 × 10-mm LAMS was then inserted over the wire from the anal side and successfully deployed across the anastomosis ([Fig. 2] and [Fig. 3]; [Video 1]).

Zoom Image
Fig. 1 Fluoroscopic image showing the rendezvous approach.
Zoom Image
Fig. 2 Endoscopic view showing proper deployment of the stent across the dehiscence.
Zoom Image
Fig. 3 Fluoroscopic image showing the lumen-apposing metal stent in situ.

Video 1 The video shows the rendezvous approach being used to recanalize a coloanal anastomotic dehiscence with a lumen-apposing metal stent.

Georg Thieme Verlag. Please enable Java Script to watch the video.

The patient was discharged home in good condition 1 day after the procedure. After 2 months, a flexible sigmoidoscopy was carried out, in which the stent was removed with a forceps. The upper GI endoscope was advanced to a point proximal to the anastomosis, which was noted to be widely patent ([Fig. 4]). The stent was then reloaded into the therapeutic upper GI endoscope and redeployed across the anastomosis to ensure the area remained patent. After 4 months, the stent was removed following ileostomy reversal. The patient continues to do well after 3 months of follow-up.

Zoom Image
Fig. 4 Endoscopic view showing the patent anastomosis after stent removal.

In conclusion, treatment of postoperative coloanal anastomotic dehiscence using a LAMS placed via the rendezvous technique is feasible and effective.

Endoscopy_UCTN_Code_TTT_1AQ_2AG

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos

Correction

Sanaei O, Brewer Gutierrez O, Moran R et al. Rendezvous recanalization of a postoperative coloanal anastomotic dehiscence with a lumen-apposing metal stent. Endoscopy 2018, 50: doi:10.1055/a-0591-2148
In the above mentioned article the page numbers have been corrected.
This was corrected in the online version on August 17, 2018.


#

Competing interests

Mouen A. Khashab is a consultant and on the medical advisory board for Boston Scientific and Olympus. The remaining authors have nothing to disclose.


Corresponding author

Mouen A. Khashab, MD
Johns Hopkins Hospital
1800 Orleans Street
Sheikh Zayed Tower
Baltimore, MD 21287
USA   
Phone: +1-443-287-1960   


Zoom Image
Fig. 1 Fluoroscopic image showing the rendezvous approach.
Zoom Image
Fig. 2 Endoscopic view showing proper deployment of the stent across the dehiscence.
Zoom Image
Fig. 3 Fluoroscopic image showing the lumen-apposing metal stent in situ.
Zoom Image
Fig. 4 Endoscopic view showing the patent anastomosis after stent removal.