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

Abstract

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 (<1 cm) (1/21 [4.8%]) (P = .032). There were no significant procedure-related complications. LIMITATION: Our study included a small number of patients. Therefore, further prospective randomized controlled trials are needed. CONCLUSIONS: A modified method of incisional therapy as a primary treatment is safe and feasible, and appears to maintain a longer duration of patency in benign anastomotic esophageal stricture.