CORTICOSTEROID INJECTION after dilatation can be effective .

Dis Colon Rectum. 2005 Apr;48(4):862-5.

The strictured anastomosis: successful treatment by corticosteroid injections--report of three cases and review of the literature.

Lucha PA Jr1, Fticsar JE, Francis MJ.

Dear Dr Mantoo

after confirmation of stenosed anastomosis site via full colonoscopy with biopsy and rule out cancer recurrnce , re anastomosis with round GI stapler ( ETICON stapler 29 or 33) is recommended.after laparotomy , insert anvil of stapler via colostomy above stricture and hand pice from rectum make anastomosis.

Dear Habibollah, this is a Colo Anal not a high colo-rectal anastomosis.

With a colo-anal recurrent stenotic anastomosis you can try a doble "S" advancement flap after removing all the scarred tissue from the original anastomosis.

I perfome RIC (radial incision and cutting) procedure to colorectal anastomosis. Never tried to a coloanal, but can be an option...

We do not treat colo-anal stenosis endoscopically, but we have some experience and good results treating stenotic colo-rectal anastomoses with dilation plus injection of C-Mitomicin. 

Dear Dr. Valenzuela very interesting comment, would you like to tell us more about how Mytomicin C works in the sacarred tissue?.  Is the dilatation procedure or the Mytomicn C the factor that is working with your patients, do you have a randomized groups?  How many cases? or is just a case control observatíon. 

Our first experience was at treating refractory esophageal stenosis in children. We have a series of 6 children with refractory stenosis treated either with biodegrable stents, injection of C-Mitomycin or both. The results of this work are nowadays in press. 

As our experience with this drug was satisfactory we decided to try its use in refractory colo-rectal stenosis. We have only a few patients for the moment, all of them with stenosis treated with dilation in several occasions, with no response or restenosis in short periods of time. In these patients we perform a dilation of the stricture and after that we make the injection of C-Mitomycin. Our results are good for the moment, but we have only a few patients and the follow-up is not very long. 

The effect of C-Mitomycin on the stenosis seems to be related with its capacity to inhibit the activity of fibroblasts. Evidence about this drug in this indication is weak, but it can be useful in patients in which other alternatives failed. 

Thank you very much Dr. Valenzuela very enlightening this approach to colon stenosis., my email address is [email protected] and I would like to be in touch with you.

Best regards.

I agree completely with Fabio.

These stenosis are caused by fibrous retraction of stapled anastomosis, due to the persistence of a circular ulceration at thejunction of the two walls.

In case of any doubt and if a thin scope fails to go through, barium enema will confirm this mechanism and mesure the height to be cut . Then, it's easy to introduce a cutting device like sphincterotome or needle and cut the occluding membrane. It's thick because it's made of two complete walls. It's easy to make 3 to 4 incisions, leaving a few mm to avoid perforation. 

As a matter of fact, dilation tears only one part of membrane, leading to frequent stenosing scaring. I started 30 y. ago, before stenting and never encountered a single failure in this type of stenosis. However, removable stents are much more expensive and less efficient.