Department of Upper Gastrointestinal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
Academic Unit of Surgery, University of Sheffield, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
Surg Endosc. 2024 Nov;38(11):6771-6777. doi: 10.1007/s00464-024-11150-w. Epub 2024 Aug 19.
Anastomotic strictures following esophagectomy occur frequently and impact on nutrition and quality of life. Although strictures are often attributed to ischemia and anastomotic leaks, the role of anastomosis size and pyloroplasty is not well evaluated. Our study aims to assess the rate of and risk factors for anastomotic stricture following esophagectomy, and the impact of treatment with regular endoscopic balloon dilatations.
Consecutive patients (n = 207) undergoing Ivor Lewis esophagectomy performed by two surgeons at our institution were included. Data on patient demographics, surgical outcomes and anastomotic strictures were recorded. Relationship of anastomotic strictures with circular stapler size, pyloroplasty and anastomotic leak was analyzed. Treatment of strictures with endoscopic balloon dilatation was reviewed and percentage weight loss at 1 year was evaluated.
Anastomotic strictures occurred in 17.4% of patients. Patient demographics between those with and without stricture were similar. Stricture rate was similar in patients with or without pyloroplasty (13.9% vs 21.7%, respectively, p = 0.14) and in those with or without an anastomotic leak (25.0% vs 16.6%, respectively, p = 0.345). Stricture risk increased with smaller sized stapler (25 mm = 33.3%, 28 mm = 15.3%, 31 mm = 4.8%; p = 0.027). The median number of dilatations required to fully treat strictures was 2 (IQR: 1-3). The median length of time from surgery to first dilatation was 2.9 months (IQR: 2.0-4.7) and to last dilatation was 6.1 months (IQR: 4.8-10.0). Median maximum dilatation diameter was 20 mm (IQR: 18.0-20.0). There were no complications from dilatations. Percentage weight loss at 1 year in patients with strictures was similar to those without strictures (8.7% vs 11.1%, respectively, p = 0.090).
Post-esophagectomy anastomotic strictures are common and not necessarily related to anastomotic leaks or absence of pyloroplasty. Smaller anastomosis size was strongly linked with stricture formation. A driven approach with regular endoscopic balloon dilation is safe and effective in treating these strictures with no excess weight loss at 1 year once treated.
食管切除术后吻合口狭窄很常见，会影响营养和生活质量。尽管狭窄通常归因于缺血和吻合口漏，但吻合口大小和幽门成形术的作用尚未得到很好的评估。我们的研究旨在评估食管切除术后吻合口狭窄的发生率和危险因素，以及定期行内镜球囊扩张治疗的效果。
连续纳入在我院接受 Ivor Lewis 食管切除术的 207 例患者（均由两位外科医生施行）。记录患者的人口统计学资料、手术结果和吻合口狭窄情况。分析吻合口狭窄与吻合器口径、幽门成形术和吻合口漏的关系。回顾吻合口狭窄的内镜球囊扩张治疗情况，并评估 1 年后的体重丢失百分比。
17.4%的患者发生吻合口狭窄。有和无狭窄患者的人口统计学资料相似。行或不行幽门成形术患者的狭窄发生率相似（分别为 13.9%和 21.7%，p=0.14），吻合口漏患者的狭窄发生率也相似（分别为 25.0%和 16.6%，p=0.345）。吻合口狭窄风险随吻合器口径减小而增加（25mm 为 33.3%，28mm 为 15.3%，31mm 为 4.8%；p=0.027）。完全治疗狭窄所需的内镜球囊扩张中位数为 2 次（IQR：1-3 次）。从手术到首次扩张的中位时间为 2.9 个月（IQR：2.0-4.7 个月），从手术到最后一次扩张的中位时间为 6.1 个月（IQR：4.8-10.0 个月）。最大扩张直径的中位数为 20mm（IQR：18.0-20.0mm）。扩张治疗无并发症。有狭窄患者和无狭窄患者 1 年后的体重丢失百分比相似（分别为 8.7%和 11.1%，p=0.090）。
食管切除术后吻合口狭窄很常见，不一定与吻合口漏或无幽门成形术有关。较小的吻合口大小与狭窄形成密切相关。采用积极的内镜球囊扩张治疗方法安全有效，治疗后 1 年无额外体重丢失。
