The Efficacy of Endoscopic Dilatation for Benign Esophageal Stoma Stricture After Total Gastrectomy or Pylorus Preserving Proximal Gastrectomy

Abstract

Backgrounds/Aims: Esophageal stoma stricture after total gastrectomy or pylorus preserving proximal gastrectomy for proximal gastric cancer was rare but serious complication. So, Endoscopic dilatation could be used for resolving it. We estimated the efficacy of endoscopic dilatation for benign esophageal stoma stricture after operation. Methods: Between January 2001 and December 2007, Fifty-four patients diagnosed benign esophageal stoma stricture after total gastrectomy (TG group, n=28) or pylorus preserving proximal gastrectomy (PG group, n=26) were enrolled. Endoscopic dilatations including TTS (Through The Scope) balloon dilation or self-expandable covered metallic stent was inserted for 2 weeks. The efficacy of dilatation according to operation methods analyzed, retrospectively. Results: Baseline characteristics, including mean age, sex, radiation, chemotherapy, hypertension, diabetes, mean dysphagia score, stricture identified time except stage did not differ between TG group and PG group. After 1st session of balloon dilatation, No effect, Poor, Fair and Cure rate(%) between TG group and PG group were 7.1 vs. 11.5, 14.3 vs. 26.9, 21.4 vs. 26.9, 57.1 vs. 34.6, respectively. After 2nd and 3rd session, cure rate was 75 vs. 53.8 and 78.6 vs. 57.7. But, the efficacy of balloon dilatation according to operation method had no significant difference. After self-expandable covered metallic stent for patients(n) who were not cured by balloon dilatation was inserted for 2 weeks (TG vs. PG = 6 vs. 11), cure rate was improved (TG vs. PG = 89.3 vs. 76.9) but, not significantly different, too. In cured patients, total number of balloon dilatation between TG group and PG group had significant difference (1.3 vs. 1.7, p=0.018). Total number of endoscopic dilatation including stent insertion was more greater in PG group (1.5 vs. 2.1, p=0.013), too. Complications(n) were restenosis (2 vs. 7, p=0.071) and reflux esophagitis (11 vs. 8, p=0.577). Conclusions: We conclude that Endoscopic dilatations including TTS balloon dilatation or self-expandable covered metallic stent insertion is safe and effective for patients with benign esophageal stoma stricture after total gastrectomy and pylorus preserving proximal gastrectomy, and stricture after proximal gastrectomy has more frequent balloon dilatation.