Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management.
The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3-year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty-three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor-related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor-related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor-related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.
Department of Surgery, St Thomas' Hospital, London, UK. rp_sutcliffe@yahoo.co.uk
R P
RP
Sutcliffe
M J
MJ
Forshaw
R
R
Tandon
A
A
Rohatgi
D C
DC
Strauss
A J
AJ
Botha
R C
RC
Mason
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*