EP429 - Navigating the narrow path: A novel rendezvous fluoroscopic approach to the management of sigmoid stricture

Sunday, May 11, 2025

1:02 PM – 1:07 PM PT

Location: Monitor 4, Sails Pavilion, Upper Level

ePoster Presenter(s)

BR

Betsy Rodriguez, DO (she/her/hers)

Surgery Resident
Memorial Hospital System
HMH- Palisades Medical Center
Dania Beach, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AL

Asher E. Lippe, DO

General Surgery Resident
Hackensack Meridian Health
North Bergen, New Jersey, United States

Disclosure information not submitted.
MM

Megha Mehta, n/a

Medical Student
St. George’s University School of Medicine
Hasbrouck heights, New Jersey, United States

Disclosure information not submitted.
DG

Daniel Garcia, MD

General surgeon
Broward medical center
dania, Florida, United States

Disclosure information not submitted.
RL

Rosario Ligresti, MD, FASGE

Chief of Gastroenterology
Hackensack University Medical Center
Hackensack, New Jersey, United States

Disclosure information not submitted.

Senior Author(s)

GG

Gregory J. Gallina, MD, FASCRS

Senior Attending Surgeon
Hackensack University Medical Center
Maywood, New Jersey, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

NH

Nader A. Haddad, MS4

Medical Student
St. George's University
Robbinsville, New Jersey, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Betsy Rodriguez, DO: This individual has no financial relationships with ineligible companies.

Gregory J. Gallina, MD, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: 65-year-old male with history of locally advanced sigmoid adenocarcinoma initially en bloc sigmoidectomy partial cystectomy complicated by anastomotic failure, diversion and reversal, ultimately leading to recurrent colonic strictures at the anastomosis causing large bowel obstruction. Patient underwent diverting loop ileostomy. In efforts to avoid re-operation, patient underwent a novel approach of stent stent deployment guided by hybrid method of fluoroscopy from the rectum and direct visualization from a second colonoscope which was navigated proximally from his stoma.

Methods/Interventions: Patient underwent endoscopy via ileostomy with ultra thin colonoscope, until the obstruction was reached. A formal colonoscopy was simultaneously performed to the proximal-most point distally of the obstruction. Using fluoroscopy, a 22 gauge needle pierced the obstructed colon and 0.018 guide wire was passed through which was visualized and snared by the proximal ultra thin endoscope. 7fr dilator was introduced, wire was upsized to 0.035 size and balloon dilatation followed by TTS stent deployment was successful. Clips were left at the distal margin of the obstruction for reference of possible stent migration.

Results/Outcomes: Patient tolerated procedure well. Underwent interval flexible sigmoidoscopy 1 month later which revealed stent in place and lumen patent. He subsequently underwent contrast enema and repeat sigmoidoscopy and underwent ileostomy reversal 3 months post procedure and has recovered uneventfully to date. Upon reversal of ileostomy and normal passage of stool per rectum, the stent was defecated.

Conclusion/Discussion: This case underscores the complexities involved in managing colonic strictures, particularly in patients with extensive surgical histories. Current literature emphasizes the effectiveness of endoscopic techniques, including balloon dilation and stent placement, in treating such complications .The recurrent nature of the patient’s strictures illustrates the need for ongoing monitoring and potential interventions post-surgery.
Previous studies indicate that combined endoscopic approaches may enhance outcomes. This case exemplifies the creativity of two minimally invasive modalities to resolve a maximally invasive dilemma, and collaboration between specialties which ultimately lead to improved patient outcome.