Figure 4

Endoscopic appearance of the anastomotic ring. Before the procedure, the anastomosis was completely obstructed. The expected location of the circular stapler ring is shown by dotted black line (upper left). The center of the circular stapler line was slightly depressed (black arrow, upper left). A single diverticulum was present near the anastomosis (white arrow, upper left). After penetration and dilatation by the guide wire and dilators, the anastomosis was opened (upper right) and easily facilitated the through-the-scope hydrostatic balloon dilator (lower left). After applying hydrostatic balloon dilatation, the fiberscope could easily go through the anastomosis (lower right).