Management of persistent gastroesophageal anastomotic strictures with removable self-expandable polyester silicon-covered (Polyflex) stents: an alternative to serial dilation.
BACKGROUND
A benign gastroesophageal anastomotic stricture occurs in up to 42% of patients after transhiatal esophagectomy for esophageal cancer. Management of anastomotic strictures may require extended periods of serial endoscopic dilation, with significant risk, cost, and inconvenience for the patient.


OBJECTIVE
To determine if placement of removable self-expandable polyester silicon-covered (Polyflex) stents (SEPSs) prolonged the interval between endoscopic interventions in the management of persistent anastomotic stricture.


METHODS
Retrospective cohort study.


METHODS
National Cancer Institute designated comprehensive cancer center.


METHODS
Eight patients after a transhiatal esophagectomy referred for management of benign persistent anastomotic strictures.


METHODS
Serial balloon and bougie dilations and SEPS placement.


METHODS
The interval between endoscopic interventions and the number of endoscopic interventions before and after SEPS placement.


RESULTS
Over a 365-day period, 13 SEPS were placed in 8 patients with benign persistent anastomotic strictures after a transhiatal esophagectomy. A SEPS placement delayed the interval between endoscopic interventions from a mean of 7 days before stent insertion to 62 days after insertion (P < .008). The median number of preinsertion interventions was 4 and was reduced to 1 after insertion (P < .005).


CONCLUSIONS
The small number of patients.


CONCLUSIONS
A SEPS placement did not result in stricture resolution or stabilization after SEPS removal. The SEPS migration rate was much higher in our patients with postesophagectomy anastomotic strictures than previously reported for other types of strictures. However, a SEPS placement did significantly delay the interval between endoscopic interventions in patients with persistent gastroesophageal anastomotic strictures after transhiatal esophagectomy. SEPS placement should be considered as an alternative to continued serial dilation in patients with persistent anastomotic strictures after transhiatal esophagectomy.
Barthel
James S
JS
H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Florida, USA.
Kelley
Scott T
ST
Klapman
Jason B
JB
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D004867:Equipment Design; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D012189:Retrospective Studies; D012825:Silicon; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D011091:Polyesters; D012825:Silicon