A CASE OF A RECTAL ANASTOMOTIC STRICTURE TREATED WITH AN ENDOSCOPIC DIODE LASER

Abstract

A 70-year-old male had undergone low anterior resection for rectal cancer. Anastomotic leakage after the surgery had induced a severe anastomotic stricture making defecation difficult and which had proved resistant to several treatment attempts with balloon dilation and bougienage. Colonoscopy and a Gastrografin enema examination demonstrated a pinhole stenosis of the anastomosis. As there was no cancer recurrence around the stricture, endoscopic diode laser therapy was then selected.
We used a compact diode laser system (UDL-60 Olympus) via colonoscopy. Although this system has equal clinical advantages to the Nd : YAG laser, it is smaller and more portable. The colonoscope was introduced into the rectum, and was positioned optimally to the rectal stenosis. The tissue surrounding the stenosis was penetrated using the contact endoprobe of the diode laser system, and removed with biopsy forceps. No complications such as bleeding or perforation occurred. After the treatment, the stenosis had improved and good progress was maintained for 1 year and 9 months without any recurrence. We therefore concluded that endoscopic diode laser therapy could be one of the promising treatment options for severe anastomotic rectal strictures.