Refractory cervical esophagogastric anastomotic strictures

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

J Thorac Cardiovasc Surg 2011;141:444-448

© 2011 The American Association for Thoracic Surgery

General Thoracic Surgery

Refractory cervical esophagogastric anastomotic strictures: Management and

outcomes

J. , BSa,*,

Lili Zhao, PhDb,

C. Chang, MDc,

Mark B. Orringer, MDc

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

Mich

b University of Michigan Comprehensive Cancer Center, Section of Thoracic

Surgery, Ann Arbor, Mich

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

Mich

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

Ojai, California, June 23–26, 2010.

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@...).

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.

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.

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, 20

(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).

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.

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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