EUS-guided rendezvous fistula creation for complete anastomotic stenosis after low anterior resection.

Background and Aims: Complete luminal stenosis at the colorectal anastomosis after low anterior resection is a rare adverse event. Methods: We present a novel case with rendezvous via a diverting ileostomy and a retrograde EUS-guided formation of a new colorectal anastomosis for recanalization. Results: A 52-year-old previously healthy man presented with rectal bleeding and was found to have locally advanced (T3N1) adenocarcinoma. The patient received neoadjuvant chemoradiation and then underwent an uncomplicated low anterior resection with a diverting loop ileostomy. During surveillance sigmoidoscopy 6 months later, complete stenosis of his anastomosis was seen, and he was referred to advanced endoscopy. He underwent dual-operator colonoscopy and ileoscopy with confirmation of complete stenosis of the anastomosis. Using EUS, we deployed a lumen-apposing metal stent for de novo colorectal fistula formation. The patient was discharged home and has since undergone successful takedown of his ileostomy. He has remained without recurrent anastomotic narrowing on routine follow-up. Conclusions: Although complete stenosis of colorectal anastomosis is rare, we argue for the role and safety profile of EUS-guided lumen-apposing metal stent insertion given the ability to distend the proximal aspect of the colon with water to create an accessible target for fistula creation, which offers a minimally invasive alternative to major surgery.