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Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies

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Abstract

Background and Aims

This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).

Materials and Methods

Patients with anastomotic strictures (enrolled during January 1996–December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.

Results

Of the 142 patients, 124 (mean age—44.02; males—74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2–10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.

Conclusion

Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.

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Abbreviations

CAS:

Caustic anastomotic strictures

NCAS:

Non-caustic anastomotic strictures (malignancy of head/neck/esophagus)

TTS:

Through the scope

CRE:

Controlled radial expansion

PDI:

Periodic dilation index

SEMS:

Self-expanding metal stents

THE:

Trans-hiatal esophagectomy

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Funding

The study was not supported by any funding or grants.

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Rakesh Kochhar, Sarthak Malik, Yalaka Rami Reddy, Usha Dutta, Narendra Dhaka, Saroj Kant Sinha & Bipadabhanjan Mallick

  2. Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    T. D. Yadav & Vikas Gupta

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  1. Rakesh Kochhar
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  2. Sarthak Malik
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  9. Vikas Gupta
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Correspondence to Rakesh Kochhar.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards and formal ethical clearance of the institutional ethics committee of Postgraduate Institute of Medical Education and Research, Chandigarh (20th April 2018 with registration number NK/4377/RES/172) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kochhar, R., Malik, S., Reddy, Y.R. et al. Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies. Dysphagia 35, 73–83 (2020). https://doi.org/10.1007/s00455-019-10004-1

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