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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2011

01-03-2011

Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes

Authors: Dimitrios Xinopoulos, Dimitrios Kypreos, Stefanos P. Bassioukas, Dimitrios Korkolis, Konstantinos Mavridis, Andreas Scorilas, Dimitrios Dimitroulopoulos, Argyro Loukou, Emmanouel Paraskevas

Published in: Surgical Endoscopy | Issue 3/2011

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Abstract

Background

Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder–Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method.

Methods

A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder–Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated.

Results

Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder–Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 € compared with 680 €, respectively; p < 0.001).

Conclusion

Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder–Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.
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Metadata
Title
Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes
Authors
Dimitrios Xinopoulos
Dimitrios Kypreos
Stefanos P. Bassioukas
Dimitrios Korkolis
Konstantinos Mavridis
Andreas Scorilas
Dimitrios Dimitroulopoulos
Argyro Loukou
Emmanouel Paraskevas
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 3/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1247-z

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