Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, China.
Department of GI Medicine, The First Affiliated Hospital of Zhengzhou University, Henan, China.
Thorac Cancer. 2022 Jun;13(11):1570-1576. doi: 10.1111/1759-7714.14389. Epub 2022 Apr 28.
Balloon dilatation (BD) is a common treatment for esophagogastric anastomotic stricture (EAS), but with complications. This study investigates the risk factors, prevention, and management of BD complications to provide clinical guidance.
We retrospectively analyzed the clinical data of 378 patients with EAS treated by BD from March 2011 to June 2021. The association between esophagogastric anastomotic rupture outcome and patient and stricture characteristics and treatment were analyzed by logistic regression.
BD was performed 552 times and technical success, 98.0%; overall clinical success, 97.8%; major adverse events, 1.3%; minor adverse events, 9.4%; mortality, 0.3%. Logistic regression showed that age (p = 0.080), sex (p = 0.256), interval from surgery to stricture development (p = 0.817), number of dilatations (p = 0.054), cause of stricture (p ≥ 0.168), and preoperative chemotherapy (p = 0.679) were not associated with anastomotic rupture. Balloon diameter (p < 0.001), preoperative radiotherapy (p = 0.003), and chemoradiotherapy (p = 0.021) were correlated with anastomotic rupture. All patients with type I and II ruptures resumed oral feeding without developing into type III rupture. Type III rupture occurred in six cases, who resumed oral feeding after 7-21 days of nasal feeding and liquid feeding. One patient died of massive bleeding after BD.
Symptomatic treatment for type I and II ruptures and transnasal decompression and jejunal nutrition tubes for type III rupture, are suggested pending rupture healing. Tumor recurrence, preoperative radiotherapy, and balloon diameter affected the anastomotic rupture outcome.
球囊扩张（BD）是治疗食管胃吻合口狭窄（EAS）的常用方法，但存在并发症。本研究旨在探讨 BD 并发症的危险因素、预防和处理，为临床提供指导。
回顾性分析 2011 年 3 月至 2021 年 6 月期间 378 例 EAS 患者的临床资料，采用 logistic 回归分析吻合口破裂结局与患者和狭窄特征及治疗的关系。
共行 BD 552 次，技术成功率 98.0%；总体临床成功率 97.8%；主要不良事件发生率 1.3%；轻微不良事件发生率 9.4%；死亡率 0.3%。logistic 回归显示，年龄（p=0.080）、性别（p=0.256）、手术至狭窄发展的时间间隔（p=0.817）、扩张次数（p=0.054）、狭窄原因（p≥0.168）和术前化疗（p=0.679）与吻合口破裂无关。球囊直径（p<0.001）、术前放疗（p=0.003）和放化疗（p=0.021）与吻合口破裂相关。所有 I 型和 II 型破裂患者均恢复经口进食，未发展为 III 型破裂。6 例发生 III 型破裂，经鼻饲和肠内营养管喂养 7-21 天后恢复经口进食。1 例患者 BD 后因大出血死亡。
对于 I 型和 II 型破裂，建议对症治疗，对于 III 型破裂，建议行经鼻减压和空肠营养管治疗，等待破裂愈合。肿瘤复发、术前放疗和球囊直径影响吻合口破裂结局。
