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.
Abbreviation:
IT-knife (insulated-tip-knife)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 12, 2009
Accepted:
July 4,
2008
Received:
February 19,
2008
Cheonan, Choongnam, KoreaFootnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you want to chat with an author of this article, you may contact him at [email protected]
Identification
Copyright
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
