**4.3 Anastomotic stenosis**

It can sometimes be treated endoscopically, when surgery is contraindicated, by performing, as was found in a case report by Deng and team [13] with minimally invasive endoscopic approach was adopted to repair the obstruction. A needle knife was used to puncture the linear white scar, and contrast agent was injected under endoscopy and fluoroscopic guidance. Fluoroscopically, the proximal bowel was identified and a dual knife-mediated membrane puncture was performed. A guidewire was then passed through the incision into the proximal bowel and progressive pneumatic dilatation was performed successively with a controlled radial expansion balloon dilator until a 1.8-cm-diameter dilation was achieved. After conventional balloon dilatation, the endoscope easily passed through the anastomosis without any patient discomfort. There were no postoperative signs of immediate or delayed complications (**Figure 13**).

**Figure 12.** *Illustration of a simple abdominal X-ray exam in a patient with bowel obstruction.*

**Figure 13.** *Colonoscopic aspect of a anastomotic stenosis.*
