Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial.
OBJECTIVE
The primary aim of this study was to evaluate if the use of proton pump inhibitors (PPIs) reduced the prevalence of benign anastomotic strictures after uncomplicated esophagectomies with gastric tube reconstruction and circular stapled anastomoses.


BACKGROUND
Benign anastomotic strictures are associated with anastomotic leaks or conduit ischemia. Also patients without those complications develop benign anastomotic strictures. We hypothesize that patients without postoperative anastomotic complications may develop benign anastomotic strictures due to exposure of acid gastric tube contents to the anastomotic area, and that the formation of such strictures may be reduced by prophylactic use of PPIs.


METHODS
Eighty patients without preoperative chemo- or radiotherapy, without clinical or radiological signs of anastomotic leaks were included in this clinical trial. The patients were randomized to b.i.d. PPIs or no treatment for 1 year. Benign anastomotic strictures were defined as anastomotic narrowing not allowing a standard diagnostic endoscope to pass without dilatation. The study was registered in the EudraCT database (2009-009997-28) for clinical trials.


RESULTS
: Seventy-nine patients were evaluated. Benign anastomotic strictures developed in 5/39 (13%) patients in the PPI group and in 18/40 (45%) in the control group (RR 5.6, 95% CI: 2.0-15.9, P = 0.001). The use of a narrower 25 mm cartridge as compared to a wider 28 or 31 mm cartridge significantly increased stricture formations (RR 2.9, 95% CI: 1.1-7.6, P = 0.025).


CONCLUSIONS
Prophylactic PPI treatment reduced the prevalence of benign anastomotic strictures following esophagectomy with gastric tube reconstruction and circular stapled anastomoses. Larger sized circular staple cartridges additionally reduced the stricture prevalence.
Department of Surgery, Lund University Hospital, S-22185 Lund, Sweden. JAN.JOHANSSON@MED.LU.SE
Jan
J
Johansson
Stefan
S
Oberg
Jörgen
J
Wenner
Thomas
T
Zilling
Folke
F
Johnsson
Christer Staël
CS
von Holstein
Bruno
B
Walther
D000714:Anastomosis, Surgical / Q000009:adverse effects; D004106:Dilatation; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D050782:Esophageal pH Monitoring; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling
D054328:Proton Pump Inhibitors