COLONOSCOPIC FEATURES OF COLONIC ANASTOMOSES

Colonic anastomoses are frequently encountered, but their endoscopic f eatures have never been adequately characterized. Results of 117 conse cutive colonoscopies in patients with colonic anastomoses were prospec tively studied during a 12-month period. Anastomoses were photographed , videotaped, and reviewed by the authors. The age range of patients w as 18 to 87 years, and interval from surgery extended to 42 years. An equal number of right and left colonic resections were encountered; 9 patients had subtotal colectomies. Ninety-two anastomoses were hand-se wn, and 25 were stapled. Ileal pouch-anal anastomoses were not include d. Nine common anastomotic features were identified with the following frequency of occurrence: neovascularity, 105 (89.7%); white anastomot ic edge, 64 (54.7%); disruption of haustral pattern, 64 (54.7%); radia l suture tracks, 35/92 (38.0%); exposed suture, 11/92 (11.9%); exposed staples, 6/25 (24%); scar tissue adjacent to anastomotic line, 8 (6.8 %); nondistensibility of anastomosis, 5 (4.3%); blind colonic pouch, 1 0 (8.5%). No recurrent carcinomas were noted. The site of seven anasto moses (5.5%) could not be identified. Six of these patients underwent endoscopy more than 8 years postoperatively. Of the remaining 110 pati ents, 94 (85.5%) had between two and four of the above features identi fied. in three of four patients who required dilation because of stric tures, neovascularity was not seen. We conclude that colonic anastomos es have characteristic endoscopic features. These features can be used as landmarks for definitive identification of anastomotic sites at co lonoscopy. The lack of neovascularity at a colonic anastomosis may be an indicator of relative ischemia, predisposing to stricture formation .