Comparison of the Efficacy and Safety of Endoscopic Incisional Therapy and Balloon Dilatation for Esophageal Anastomotic
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ORIGINAL ARTICLE
Comparison of the Efficacy and Safety of Endoscopic Incisional Therapy and Balloon Dilatation for Esophageal Anastomotic Stricture Gyu Young Pih 1 & Do Hoon Kim 1 & Hee Kyong Na 1 & Ji Yong Ahn 1 & Jeong Hoon Lee 1 & Kee Wook Jung 1 & Kee Don Choi 1 & Ho June Song 1 & Gin Hyug Lee 1 & Hwoon-Yong Jung 1 Received: 30 March 2020 / Accepted: 26 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Benign esophageal anastomotic strictures have typically been treated using endoscopic methods, often with balloon dilatation (BD). However, recurrent esophageal strictures after BD have been reported. We evaluated the efficacy and safety of endoscopic incisional therapy (EIT) and BD for treating an anastomotic stricture after a total gastrectomy. Methods Subjects who underwent EIT or BD as a first treatment for esophagojejunostomy anastomotic stricture after a total gastrectomy between January 2010 and December 2018 were eligible. The medical records of these cases were retrospectively reviewed. Stricture was defined as an inability to pass a normal diameter endoscope (10.2 mm). The stricture area was incised under direct vision with the nano-insulated-tip knife in a radial fashion parallel to the longitudinal axis of the esophagus. Results Twenty-one patients in our database presented with benign anastomotic stricture after a total gastrectomy for advanced gastric cancer. The BD group included 12 patients. The remaining nine patients underwent EIT, and three of these cases received an immediate additional BD. The re-stricture rate was significantly different between the BD and EIT groups (41.7% vs. 0%, respectively; P = 0.045). There were no significant differences in procedure time, interval from surgery to first stricture, hospitalization period, or complication rates between the groups. One patient developed a microperforation during BD and was treated without surgical intervention. Conclusions EIT is a safe and effective primary treatment modality compared with BD for esophagojejunostomy anastomotic stricture after a total gastrectomy as it shows a significantly lower re-stricture rate. Keywords Esophagus . Anastomotic stricture . Endoscopy
Introduction Benign esophageal anastomotic stricture is one of the major postoperative complications, occurring in 5 to 46% of patients.1–3 Balloon dilatation (BD) has been a common modality worldwide for treating an anastomotic stricture, but the frequent onset of recurrent refractory esophageal strictures after a BD has been reported, which leads to a deterioration in the quality of life in the affected patients.1–5 Prior studies on endoscopic BD have described a 38.1–83.3% re-stricture rate. 6–9
* Do Hoon Kim [email protected] 1
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
Endoscopic incisional therapy (EIT) using an electrocautery method has recently been reported as an effective modality for benign esophageal stri
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