Epithelium-preserving stricturotomy is effective for improving postoperative benign anastomotic stricture associated with colorectal surgery.

Background and study aims: We analyzed a large sample of patients with colorectal cancer (CRC) treated with endoscopic stricturotomy (ESt) for postoperative benign anastomotic stricture (POBAS) and explored risk factors for stricture recurrence (restricture). We aimed to provide data on the long-term outcomes of ESt and support for optimizing ESt in treating and preventing POBAS recurrence.

Patients and methods: This retrospective study included 152 consecutive patients with CRC diagnosed with POBAS and treated by ESt at our center from April 2013 to April 2023. The primary outcome was stricture recurrence. Secondary outcomes were the technical success rate, postoperative adverse events (AEs), and restricture-free survival (RFS). Risk factors for stricture recurrence were explored.

Results: Of the 152 patients, 94.1% (143/152) achieved technical success after the first ESt. Twenty-two patients (17.5%) were diagnosed with recurrent stricture among 126 initial successful patients with follow-up. Anastomotic stricture length ≥ 1 cm and non-preservation of intestinal epithelium during ESt were independent risk factors for recurrence ( P < 0.05). The cumulative RFS rate was 82.53%.

Conclusions: Anastomotic stricture length ≥ 1 cm and non-epithelium preservatoin at ESt were independent risk factors for restricture after ESt in POBAS patients. These two factors may help predict risk of POBAS recurrence and provide reliable evidence for developing personalized treatment plans for patients.