Segmental layered incision and circumferential endoscopic dissection technique of endoscopic stricturotomy for safe, staged endoscopic dissection of complex luminal stricture.

Background and Aims: Management of tight, fibrotic colonic strictures remains a challenge because of the risk of bleeding or perforation with conventional radial stricturotomy. We describe a novel segmental layered incision and circumferential endoscopic dissection (SLICE) technique, inspired by endoscopic submucosal dissection, designed to improve precision and safety during endoscopic stricture therapy. Methods: A 32-year-old woman with a 2.5-cm fibrotic colonic stricture at the splenic flexure, presumed secondary to tuberculosis, presented with subacute obstruction. Over 3 consecutive days, SLICE was performed using an insulated-tip knife nano (Olympus, Tokyo, Japan) in a staged manner, progressively dissecting the stricture wall in circumferential, shallow layers. Electrosurgical settings used were ENDO CUT I (effect 3, duration 1, interval 3) on the VIO 300 D unit (Erbe Elektromedizin GmbH, Tübingen, Germany). Results: The stricture was safely traversed with a pediatric colonoscope after staged dissection totaling 5 hours. No perforation or bleeding occurred. At 6-month follow-up, intestinal ultrasound confirmed resolution of obstruction, and endoscopy showed only mild mucosal reapproximation with sustained luminal patency. A clip-based endoscopic stricturoplasty was performed to prevent reapproximation. Conclusions: SLICE offers a reproducible, layered approach for complex fibrotic strictures and may reduce the risk of adverse events in high-risk locations. Long-term validation and procedural standardization are warranted.