Chi J, Luo GY, Shan HB, Lin JZ, Wu XJ, Li JJ. Recanalization of anastomotic occlusion following rectal cancer surgery using a rendezvous endoscopic technique with transillumination: A case report. World J Gastroenterol 2024; 30(37): 4149-4155 [DOI: 10.3748/wjg.v30.i37.4149]
Corresponding Author of This Article
Jian-Jun Li, MD, Chief Physician, Department of Endoscopy, Sun Yat-Sen University Cancer Center, No. 651 Dong-Feng Road East, Guangzhou 510060, Guangdong Province, China. lijj@sysucc.org.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 7, 2024; 30(37): 4149-4155 Published online Oct 7, 2024. doi: 10.3748/wjg.v30.i37.4149
Recanalization of anastomotic occlusion following rectal cancer surgery using a rendezvous endoscopic technique with transillumination: A case report
Jun Chi, Guang-Yu Luo, Hong-Bo Shan, Jun-Zhong Lin, Xiao-Jun Wu, Jian-Jun Li
Jun Chi, Guang-Yu Luo, Hong-Bo Shan, Jian-Jun Li, Department of Endoscopy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Jun Chi, Guang-Yu Luo, Hong-Bo Shan, Jun-Zhong Lin, Xiao-Jun Wu, Jian-Jun Li, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
Jun Chi, Guang-Yu Luo, Hong-Bo Shan, Jun-Zhong Lin, Xiao-Jun Wu, Jian-Jun Li, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
Jun-Zhong Lin, Xiao-Jun Wu, Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Co-first authors: Jun Chi and Guang-Yu Luo.
Co-corresponding authors: Xiao-Jun Wu and Jian-Jun Li.
Author contributions: Li JJ, Lin JZ, and Wu XJ designed the procedure; Chi J, Luo GY, and Shan HB collected the case information; Chi J and Luo GY completed the manuscript draft; Li JJ and Wu XJ revised the paper. Final approval of the manuscript was obtained from all the authors.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Jun Li, MD, Chief Physician, Department of Endoscopy, Sun Yat-Sen University Cancer Center, No. 651 Dong-Feng Road East, Guangzhou 510060, Guangdong Province, China. lijj@sysucc.org.cn
Received: March 7, 2024 Revised: September 3, 2024 Accepted: September 10, 2024 Published online: October 7, 2024 Processing time: 203 Days and 2.6 Hours
Abstract
BACKGROUND
Colorectal anastomotic occlusion is a serious complication of colorectal cancer surgery. Although several treatment strategies have been proposed, the management of anastomotic occlusion remains challenging. In this report, we present a case of anastomotic occlusion recanalization performed using a novel technique involving two endoscopes, one for radial incision and the other serving as a guide light. This novel technique offers significant advantages in terms of operational feasibility, reduced invasiveness, rapid recovery, and shortened hospital stay.
CASE SUMMARY
A 37-year-old man underwent low anterior resection and prophylactic double-lumen ileostomy for rectal cancer in June, 2023. Two months later, complete anastomotic occlusion was observed on colonoscopy. Therefore, we developed a novel atresia recanalization technique. Two endoscopes were placed, one through the colonic anastomosis and the other through the anus. A radial incision was successfully made from the colonic side, guided by the light of the endoscope from the anal side. Atresia recanalization was performed within 20 minutes. Three weeks after recanalization, colonoscopy revealed that the diameter of the colorectal anastomosis was approximately 16 mm and the patient therefore underwent stoma reversal in September. During the follow-up period of approximately one year, the patient remained well and no stenosis or obstruction symptoms were observed.
CONCLUSION
Endoscopic atresia recanalization of colorectal anastomotic occlusion assisted by an opposing light source is safe and effective.
Core Tip: Colorectal anastomotic occlusion is a rare but serious complication of colorectal cancer surgery. Because a guidewire cannot pass through the occluded segment, the traditional endoscopic approaches of bougie or balloon dilation are difficult to implement. Previously reported endoscopic techniques have been performed under endoscopic ultrasound or fluoroscopic guidance. Here, we report a case of anastomotic occlusion that was successfully recanalized using a combined antegrade-retrograde endoscopic rendezvous technique; one endoscope was used for radial incision, the other served as a guide light. This simplified procedure is safe, rapid, and, as complicated instruments are not required, cost-effective.
