Document Detail


Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses.
MedLine Citation:
PMID:  18074183     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Endoscopic balloon dilation is the first-line treatment for benign colorectal anastomotic strictures. We aimed to objectively assess its long-term results. METHODS: Gastrointestinal symptoms and health-related quality of life (HRQoL) were assessed at long-term after balloon dilation of anastomotic strictures in 31 consecutive patients (excluding those with inflammatory bowel disease) as well as and controls, using the validated Gastrointestinal Quality of Life Index (GIQLI). Most colectomies had been performed for benign diseases, with anastomoses located at the colorectal junction. RESULTS: Completed surveys were collected from 81 subjects, including 27 study patients (response rate 87%), 27 surgical controls matched for age, gender, and indication of colectomy, and 27 healthy subjects. At a mean of 3.9 +/- 2.3 years after the first endoscopic balloon-dilation, study patients self-reported significantly more gastrointestinal symptoms than controls; these included frequent and urgent bowel movements, bloating, food restriction (p < or = 0.001, all comparisons), diarrhea, excessive passage of gas through the anus (p < 0.01, all comparisons), constipation, and abdominal pain (p < 0.05, all comparisons). Health-related quality of life was significantly impaired in study patients versus surgical controls and healthy subjects (GIQLI scores, 104 +/- 20, 119 +/- 24, and 121 +/- 16, respectively; p = 0.005). Impaired HRQoL subdimensions included gastrointestinal symptoms (p < 0.001), stress by treatment (p < 0.05), and emotional status (p = 0.08). HRQoL was independent of the delay between stricture dilation and the survey. Follow-up endoscopy (performed in 21/27 [78%] study patients, including the 7 patients with the lowest HRQoL, and 19 [70%] surgical controls) disclosed anastomoses larger than 13 mm in all cases. CONCLUSIONS: Health-related quality of life is significantly impaired at long-term after standard balloon-dilation of benign anastomotic colorectal strictures as a result of gastrointestinal symptoms and stress by treatment. This impairment might be related to the fact that an anastomotic diameter > or = 13 mm, although commonly used to define successful endoscopic treatment, is insufficient to provide long-term symptom relief in some patients, or to other, yet to be identified, factors.
Authors:
T Nguyen-Tang; O Huber; P Gervaz; J M Dumonceau
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2007-12-11
Journal Detail:
Title:  Surgical endoscopy     Volume:  22     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-09     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1660-6     Citation Subset:  IM    
Affiliation:
Service of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest, 24, 1205, Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical / adverse effects
Balloon Dilatation / methods*
Colectomy / adverse effects
Colonic Diseases / therapy*
Constriction, Pathologic / etiology,  surgery
Endoscopy / methods*
Female
Humans
Intestinal Obstruction / etiology,  therapy*
Male
Middle Aged
Population Surveillance
Quality of Life*
Rectal Diseases / therapy*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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