Korean J Gastroenterol.  2017 Feb;69(2):102-108. 10.4166/kjg.2017.69.2.102.

Clinical Outcomes of Dilation Therapy for Anastomotic Esophageal Stricture

• Choi CW
• Kang DH
• Kim HW
• Park SB
• Kim SJ
• Nam HS
• Ryu DG

• KMID: 2383419
• DOI: http://doi.org/10.4166/kjg.2017.69.2.102

Abstract

BACKGROUND/AIMS
Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture.
METHODS
Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed.
RESULTS
During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients.
CONCLUSIONS
Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length.

Keyword

Esophagus; Stricture; Dilation; Balloon; Anastomosis

MeSH Terms

Constriction, Pathologic
Deglutition Disorders
Diabetes Mellitus
Esophageal Stenosis*
Esophagectomy
Esophagus
Humans
Male
Medical Records
Retrospective Studies
Risk Factors

Reference

References

1. Honkoop P, Siersema PD, Tilanus HW, Stassen LP, Hop WC, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg. 1996; 111:1141–1146. discussion 1147–1148.

2. Heitmiller RF, Fischer A, Liddicoat JR. Cervical esophagogastric anastomosis: results following esophagectomy for carcinoma. Dis Esophagus. 1999; 12:264–269.

3. Chunwei F, Qingzeng N, Jianliang L, Weiji W. Cervical esophagogastric anastomosis with a new stapler in the surgery of esophageal carcinoma. Eur J Cardiothorac Surg. 2005; 28:291–295.

4. Pierie JP, de Graaf PW, Poen H, van der Tweel I, Obertop H. Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy. Br J Surg. 1993; 80:471–474.

5. van der Schaaf M, Derogar M, Johar A, et al. Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study. BMJ Open. 2014; 4:e004648.

6. ASGE Technology Committee. Siddiqui UD, Banerjee S, et al. Tools for endoscopic stricture dilation. Gastrointest Endosc. 2013; 78:391–404.

7. Standards of Practice Committee. Egan JV, Baron TH, et al. Esophageal dilation. Gastrointest Endosc. 2006; 63:755–760.

8. de Wijkerslooth LR, Vleggaar FP, Siersema PD. Endoscopic management of difficult or recurrent esophageal strictures. Am J Gastroenterol. 2011; 106:2080–2091. quiz 2092.

9. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005; 62:474–475.

10. Park JY, Song HY, Kim JH, et al. Benign anastomotic strictures after esophagectomy: long-term effectiveness of balloon dilation and factors affecting recurrence in 155 patients. AJR Am J Roentgenol. 2012; 198:1208–1213.

11. Mendelson AH, Small AJ, Agarwalla A, Scott FI, Kochman ML. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol. 2015; 13:263–271.e1.

12. Ramage JI Jr, Rumalla A, Baron TH, et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005; 100:2419–2425.

13. Hordijk ML, van Hooft JE, Hansen BE, Fockens P, Kuipers EJ. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc. 2009; 70:849–855.

14. Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002; 35:117–126.

15. Grooteman KV, Wong Kee Song LM, Vleggaar FP, Siersema PD, Baron TH. Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation. Gastrointest Endosc. 2017; 85:332–337.e1.

16. Scolapio JS, Pasha TM, Gostout CJ, et al. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc. 1999; 50:13–17.

17. Chiu YC, Hsu CC, Chiu KW, et al. Factors influencing clinical applications of endoscopic balloon dilation for benign esophageal strictures. Endoscopy. 2004; 36:595–600.

18. van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg. 2010; 251:1064–1069.

19. Hirdes MM, van Hooft JE, Koornstra JJ, et al. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures. Clin Gastroenterol Hepatol. 2013; 11:795–801.e1.

20. Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: Technique and results. World J Gastrointest Endosc. 2015; 7:1318–1326.

21. van Halsema EE, van Hooft JE. Clinical outcomes of self-expandable stent placement for benign esophageal diseases: A pooled analysis of the literature. World J Gastrointest Endosc. 2015; 7:135–153.

22. Thomas T, Abrams KR, Subramanian V, Mannath J, Ragunath K. Esophageal stents for benign refractory strictures: a metaanalysis. Endoscopy. 2011; 43:386–393.