Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management

Abstract

The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3-year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty-three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor-related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor-related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor-related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.

Two-phase laparoscopic-assisted oesophago-gastrectomy: a single-unit experience of 111 consecutive cases and outcomes

“…The conduitbronchial fistula rate may therefore be more a consequence of more radical surgery positioning the anastomosis in direct contact with the membranous tracheo-bronchial tree than direct injury. The anastomotic stricture rate of 12.8% is also comparable to other published series where the rate of stricture is reported to be between 10 and 38% [14,22,23].…”

Minimally Invasive Oesophagectomy: Preliminary Results after Introduction of an Intrathoracic Anastomosis

“…In a prospective series of 607 patients with a cervical anastomosis, the incidence of anastomotic stenosis and dilatation for benign strictures was 41.7% [13], which is in accordance with other publications reporting an incidence of 26-42% [8,9,10,11]. Although the present study is not comparative, the incidence of stricture formation and dilatation after an intrathoracic anastomosis seems significantly lower than that reported after a cervical anastomosis.…”

“…Benign stricture formation and recurrent laryngeal nerve trauma are common complications after oesophagectomy and cervical anastomosis, with an incidence of 26-42% [7,8,9,10,11] and around 20%, respectively [12,13,14,15]. These complications are major causes of functional morbidity causing dysphagia and hoarseness.…”

Endoscopic steroid injection reduced frequency of repeat dilation in patients with anastomotic stenosis after esophagectomy

“…The number of EBDs, measured from the beginning to the release of stricture, was significantly lower in the steroid group than in the control group [2.5 (1-6) vs. 4.5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), p = 0.033] (Fig. 2).…”

“…The incidence of anastomotic stricture ranges from 26 to 42 % in patients who have undergone esophagectomy [15][16][17]. Anastomotic stricture reduces oral intake and body weight, leading to a decrease in patient quality of life [18].…”