title: Refractory cervical esophagogastric anastomotic strictures: management and outcomes.
abstract: 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.
authors.affiliation: University of Michigan Medical School, Section of Thoracic Surgery, Ann Arbor, MI 48109-5344, USA. sjdmed@umich.edu
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Davis
authors.forename: Lili
authors.initials: L
authors.lastname: Zhao
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004106:Dilatation; D004940:Esophageal Stenosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D012648:Self Care; D013272:Stomach Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome