Management of persistent gastroesophageal anastomotic strictures with removable self-expandable polyester silicon-covered (Polyflex) stents: an alternative to serial dilation

Background

A benign gastroesophageal anastomotic stricture occurs in up to 42% of patients after transhiatal esophagectomy for esophageal cancer. Management of anastomotic strictures may require extended periods of serial endoscopic dilation, with significant risk, cost, and inconvenience for the patient.

Objective

To determine if placement of removable self-expandable polyester silicon-covered (Polyflex) stents (SEPSs) prolonged the interval between endoscopic interventions in the management of persistent anastomotic stricture.

Design

Retrospective cohort study.

Setting

National Cancer Institute designated comprehensive cancer center.

Patients

Eight patients after a transhiatal esophagectomy referred for management of benign persistent anastomotic strictures.

Interventions

Serial balloon and bougie dilations and SEPS placement.

Main Outcome Measurement

The interval between endoscopic interventions and the number of endoscopic interventions before and after SEPS placement.

Results

Over a 365-day period, 13 SEPS were placed in 8 patients with benign persistent anastomotic strictures after a transhiatal esophagectomy. A SEPS placement delayed the interval between endoscopic interventions from a mean of 7 days before stent insertion to 62 days after insertion (P < .008). The median number of preinsertion interventions was 4 and was reduced to 1 after insertion (P < .005).

Limitation

The small number of patients.

Conclusions

A SEPS placement did not result in stricture resolution or stabilization after SEPS removal. The SEPS migration rate was much higher in our patients with postesophagectomy anastomotic strictures than previously reported for other types of strictures. However, a SEPS placement did significantly delay the interval between endoscopic interventions in patients with persistent gastroesophageal anastomotic strictures after transhiatal esophagectomy. SEPS placement should be considered as an alternative to continued serial dilation in patients with persistent anastomotic strictures after transhiatal esophagectomy.

Abbreviations: SEMS, self-expandable metal stent, SEPS, self-expandable polyester silicon-covered (Polyflex) stent