Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture.

Abstract

Corrosive stricture of esophagus may be associated with variable involvement of stomach. We analyzed the outcome of gastric conduit used in the management of corrosive esophageal stricture with concomitant antro-pyloric stricture. Among 101 esophageal replacements performed, 53 patients had combined esophagus and stomach strictures. Colon was used as a conduit in 43 patients, while stomach was used in ten patients. Indications, perioperative complications and early/late outcomes of patients with gastric pull-up were reviewed and compared with those undergone colon pull-up. The indications of using gastric conduit were impromptu in four patients [colonic conduit ischemia (n=2) and an oversight of antro-pyloric stricture after forming the gastric conduit (n=2)]. Six patients had preconceived gastric conduit (distal antro-pyloric stricture with distended stomach). The median age was 29years (range 16-50), and median BMI was 15.4kg/m2 (range 14.5-20.1). The stomach was drained using loop gastrojejunostomy (n=7) or Roux-en-Y gastrojejunostomy (n=3). One patient died due to sepsis secondary to anastomotic leak. Median hospital stay was 9days (range 7-22). At median follow-up of 25months (range 14-80), the remaining nine patients are able to have solid diet and have gained weight. The level of esophageal stricture was low (p=0.01), and duration of surgery (p=0.02) and median hospital stay (p=0.04) were significantly less in patients with gastric conduit plus drainage as compared to patients undergone colonic pull-up. Gastric conduit in a subject with distal antro-pyloric stricture can be used safely along with gastrojejunostomy in selected patients of corrosive esophageal stricture.