Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture

Background Benign anastomotic esophageal stricture after surgical resection is not uncommon and requires repeated dilation sessions to maintain patency because of the significant recurrence rate with bougie or balloon dilation. Objective Our study was designed to evaluate whether a modified method o...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2009-05, Vol.69 (6), p.1029-1033
Main Authors: Lee, Tae Hoon, MD, Lee, Suck-Ho, MD, Park, Ji-Young, MD, Lee, Chang Kyun, MD, Chung, Il-Kwun, MD, Kim, Hong Soo, MD, Park, Sang-Heum, MD, Kim, Sun-Joo, MD, Hong, Su Jin, MD, Lee, Moon Sung, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Anastomosis, Surgical
Biological and medical sciences
Deglutition Disorders - surgery
Digestive system. Abdomen
Dilatation
Endoscopy
Esophageal Neoplasms - surgery
Esophageal Stenosis - surgery
Esophagoscopes
Esophagoscopy
Esophagus
Esophagus - surgery
Female
Follow-Up Studies
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Jejunum - surgery
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Postoperative Complications - surgery
Prospective Studies
Recurrence
Stomach Neoplasms - surgery
Surgical Instruments
Surgical Staplers
Treatment Outcome
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Summary:Background Benign anastomotic esophageal stricture after surgical resection is not uncommon and requires repeated dilation sessions to maintain patency because of the significant recurrence rate with bougie or balloon dilation. Objective Our study was designed to evaluate whether a modified method of incisional therapy is effective and maintains a good patency in a benign anastomotic esophageal stricture. Design A prospective outcome study. Setting Tertiary-care academic medical centers. Patients A total of 24 patients with benign anastomotic esophageal strictures after esophagojejunostomy. Interventions Under direct vision through a transparent hood, radial incisions parallel to the longitude of the esophagus were performed by pulling up the Iso-Tome or insulated-tip–knife. Main Outcome Measurements Efficacy, safety, and long-term patency after procedures were evaluated. Results During 24 months of follow-up observations, 21 of 24 patients (87.5%) who received only 1 dilation session resumed eating solid meals and had no dysphagia. Only 3 patients (12.5%) developed restricture at a mean of 1.6 months. Of the patients with a recurrence, 2 experienced no recurrence after one additional dilation session, and another patient was refractory and underwent 5 dilation sessions. The occurrence of restricture after incisional therapy was statistically more prevalent in long-segment stricture (>1 cm) (2/3 [66.7%]) than short-segment stricture (
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2008.07.018