Re: Re: Refractory cervical esophagogastric anastomotic strictures

[Guest guest]

I too shudder to think of self dilating at home. I had a transhiatal

esophagectomy done back in October 2004 and had to have up to 8 dilatations in

the first 4 weeks post op. and I most deffinately could not have endured having

them if it were not for the sedative drug that I was given pre-op.

from the UK

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From: zlmmom1 <mcnairmichelle@...>

achalasia

Sent: Wed, January 19, 2011 8:35:41 PM

Subject: Re: Refractory cervical esophagogastric anastomotic

strictures

 

you know, years ago I met a Phys Asst. who had A and she talked about self

dilating and all I can say is - ugh!! Not a chance!!

'self dilate'?!? Seriously?!?

without drugs??

I'm still shuddering just thinking about it

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> http://jtcs.ctsnetjournals.org/cgi/content/abstract/141/2/444?ct=ct

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> J Thorac Cardiovasc Surg 2011;141:444-448

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> © 2011 The American Association for Thoracic Surgery

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> General Thoracic Surgery

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> Refractory cervical esophagogastric anastomotic strictures: Management and

>outcomes

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> J. , BSa,*,

> Lili Zhao, PhDb,

> C. Chang, MDc,

> Mark B. Orringer, MDc

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> a University of Michigan Medical School, Section of Thoracic Surgery, Ann

>Arbor, Mich

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> b University of Michigan Comprehensive Cancer Center, Section of Thoracic

>Surgery, Ann Arbor, Mich

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> c University of Michigan Medical Center, Section of Thoracic Surgery, Ann

>Arbor, Mich

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> Read at the 36th Annual Meeting of The Western Thoracic Surgical Association,

>Ojai, California, June 23†" 26, 2010.

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> Received for publication June 13, 2010; revisions received September 23, 2010;

>accepted for publication October 10, 2010.

> * Address for reprints:

> J. , BS, University of Michigan Medical Center, Department of

> Surgery, Section of Thoracic Surgery, 2120 Taubman Center, Box 0344,

> 1500 East Medical Center Drive, Ann Arbor, MI 48109-5344. (Email: sjdmed@...).

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> Objective: For recalcitrant cervical esophagogastric anastomotic strictures

>after transhiatal esophagectomy, a protocol of self-dilatation was developed at

>the University of Michigan Medical Center, as previously described. This study

>was undertaken to determine the outcomes of this treatment.

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> Methods: Self-dilatation was required in 158 (7.6%) of 2075 patients with

>cervical esophagogastric anastomotic strictures after transhiatal

esophagectomy.

>An esophageal-specific survey evaluated the frequency and duration of

>dilatation, swallowing function, and satisfaction with treatment. The

>relationship among anastomotic leak, subsequent stricture, and the need for

>self-dilatation was assessed. A validated survey tool, the Short Form 36-item,

>version 2, was used to assess quality of life.

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> Results: At the time of this study, 78 of 158 patients were alive; 34 (43%)

>participated in the esophageal-specific survey. Median duration of

>self-dilatation was 10 years. The majority were satisfied with their ability to

>eat. No adverse events were reported. All patients said they would use

>self-dilatation therapy again under similar circumstances. Of these patients,

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>(59%) responded to the Short Form 36-item, version 2. Compared with the general

>population, 55% and 70% of participants scored at or above the norm for

physical

>health and mental health status, respectively. Patients who required

>self-dilatation were twice as likely to have a history of cervical

>esophagogastric anastomotic leak as those who did not require this therapy

>(P = .0002).

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> Conclusions: Refractory cervical esophagogastric anastomotic strictures are

>best managed initially with frequent outpatient dilatations, then transitioning

>to self-dilatation. Home use of Maloney dilators is a safe, well-tolerated,

>convenient, and cost-effective way to maintain comfortable swallowing. The

>effectiveness of self-dilatation therapy is reflected in this

cohort’s good

>quality of life and level of functioning.

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> Abbreviations and Acronyms CEGA = cervical esophagogastric anastomosis; ESS =

>Esophageal-Specific Survey; QOL = quality of life; SF-36v2 = Short Form

36-item,

>version 2; THE = transhiatal esophagectomy

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