Initial management of esophageal anastomotic strictures after transhiatal esophagectomy for esophageal cancer with dilations up to 18-20mm.

Abstract

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 provided data and treatment recommendations based upon these findings. A retrospective review of patients who underwent esophageal dilations ≥ 18mm up to 20mm after THE between 2006 and 2019 at our institution was performed. Patient demographics were n = 97, age = 70, 81 males. For all cases, the mean location, length, diameter of the stricture, and number of days from surgery and initial dilation were 20cm, 1.9cm, 6.7mm, and 106days, respectively. Most dilations (79%) occurred within 2weeks to 3months from surgery. 29.9% were dilated up to 18mm, 10.3% were dilated up to 19mm, and 59.8% were dilated up to 20mm upon initial dilation. Even 1-mm-diameter lesions could be safely dilated upon 18-20mm. In this study group there were no complications after endoscopic dilation that required hospitalization or further surgical or endoscopic interventions. These results suggest that early aggressive endoscopic management of esophageal anastomotic strictures after THE can be safely performed.