Andrea R Marcadis, MD, Robert D Andres, MD, PhD, Valerie Wu Chao Ying, MD, Jose M Martinez, MD, FACS. University of Miami – Miller School of Medicine / Jackson Memorial Hospital
INTRODUCTION: Esophageal anastomotic stricture is a well-known complication after transhiatal esophagectomy (THE), but there is limited data regarding the initial management and subsequent outcomes after stricture dilation. There is concern that dilating to larger diameters upon the initial encounter, specifically with high-grade strictures, will lead to increased risk for complications. We therefore reviewed one surgeon’s experience with esophageal dilations after THE and provide data and treatment recommendations based upon these findings.
METHODS: A retrospective review of patients who underwent esophageal dilations after THE between 2009-2013 at our institution was performed. Patient demographics were n=43, age=59.31, 41 males, 2 females.
RESULTS: For all cases, the average location, length, diameter of the stricture and number of days between surgery and the initial dilation were 20 cm, 1-2 cm, 6.3 mm and 106 days, respectively. Two dilations occurred within 1 month with the earliest dilation occurring within two weeks (13 days) of surgery.
Data were stratified with respect to stricture diameter and/or the ability to transverse the stricture with a pediatric or adult endoscope. Our results demonstrate a linear relationship between the diameter of the stricture and number of days from surgery to the first dilation: 1-5 mm: 63 days (n=14); 6-9 mm: 123 days (n=12); and >1 cm: 259 days (n=9); (p=0.004). 86% of the dilations for strictures 1-5 mm occurred between post-operative day (POD) 31-60, of that subgroup all pinhole lesions (1 mm) occurred between POD 41-60. 58% of 6-9 mm strictures occurred between POD 31-90, while the remaining 42% occurred between POD 91-360. 78% of strictures >1 cm occurred between POD 91-360.
We next examined the maximum diameter at which each sub-group was dilated. The majority (86%) of 6-9 mm and >1 cm strictures were dilated up to 20 mm on initial dilation. Even the smallest strictures (1-5 mm) were safely dilated up to 18 mm (57%) and 20 mm (36%).
In this study group there were no complications (ie perforation, bleeding, hematemesis, mediastinitis) after endoscopic dilation which required hospitalization or further surgical or endoscopic interventions.
CONCLUSION(S): Our results demonstrate that patients with smaller strictures required dilations sooner, within 1-2 months of surgery, when compared to larger diameter strictures. Interestingly, dilation up to 18-20 mm, even with smallest stricture sizes of 1-5 mm, resulted in no adverse sequlae. These results suggest that early aggressive endoscopic management of esophageal anastomotic strictures after THE can be safely performed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80317
Program Number: P351
Presentation Session: Poster (Non CME)
Presentation Type: Poster
