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Therapeutic colonoscopy

Colonic stricture (anastomotic or Crohn’s stricture)
Balloon dilatation of these strictures is an option. It can avoid or postpone surgery.

  • Strictures more than 5 cms in length should not be balloon dilated.
  • Dilate only fibrotic strictures without ulcer.
  • Dilate only if symptomatic.
  • Malignant stricture- never dilate

Remember:

Size of balloon
If the stenosis  is > 5mm in diameter- use 18-20 mm balloon
If the stenosis  is < 5mm in diameter- use 15 mm balloon
Pinhole stenosis- 12 mm balloon

Colorectal stent
Indications

  • Palliative decompression of advanced disease
  • Preoperative decompression- stent insertion avoids an emergency surgery with its benefit on morbidity and mortality

Types of Stent

  • Through the scope stents- inserted under direct vision
  • Inserted over a guidewire under fluoroscopic guidance

Complications
The major complications are stent migration (11 percent), perforation (4.5 percent), and reobstruction (12 percent).


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