Clinical Outcomes of Dilation Therapy for Anastomotic Esophageal Stricture

Cheol Woong Choi; Dae Hwan Kang; Hyung Wook Kim; Su Bum Park; Su Jin Kim; Hyeong Seok Nam; Dae Gon Ryu

doi:10.4166/kjg.2017.69.2.102

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Choi, Kang, Kim, Park, Kim, Nam, and Ryu: Clinical Outcomes of Dilation Therapy for Anastomotic Esophageal Stricture

Original Article

Korean J Gastroenterol 2017;69(2):102-108.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.2.102

Clinical Outcomes of Dilation Therapy for Anastomotic Esophageal Stricture

Cheol Woong Choi^1,², Dae Hwan Kang^1,², Hyung Wook Kim^1,², Su Bum Park^1,², Su Jin Kim^1,², Hyeong Seok Nam^1,², Dae Gon Ryu^1,²

¹Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

²Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence to: Dae Hwan Kang, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-1535, Fax: +82-55-360-1536, sulsulpul@naver.com

Received 12 October 2016 Revised 8 December 2016 Accepted 15 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture.

Methods

Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed.

Results

During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients.

Conclusions

Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length.

Keywords: Esophagus, Stricture, Dilation, Balloon, Anastomosis

References

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Table 1.

Characteristics of Patients and Dilations

Variable	Value
Total number of patients	21 (100)
Gender, male	17 (80.1)
Age, years	68.2±7.2
Stricture diameter at first balloon dilation
< 5 mm	10 (47.6)
6–9 mm	8 (38.1)
> 10 mm	3 (14.3)
Stricture length, mm	6.4±8.1
Dilation factors
Endoscopic balloon dilations only	14 (66.7)
Endoscopic balloon dilations+Bougie dilations	7 (33.3)
Coronary artery disease	1 (4.8)
Heart failure	2 (9.5)
Diabetes mellitus	2 (9.5)
Diagnosis date after operation, days	182 (306.6)
History of anastomotic leak	0 (0)
Decreased hemoglobin level after operation, g/dL	2.46±1.4
Prior chemoradiation	1 (4.8)

Values are presented as number (%) or mean±standard deviation.

Table 2.

Clinical Outcomes of Dilations (n=21)

Variable	Value
Technical success	21 (100)
Clinical success	16 (76.2)
Refractory stricture	6 (28.6)
Number of dilations
Balloon	3.9±2.7
Bougie	2.8±7.2
Balloon or bougie	6.8±7.6
Major complications ^a	0 (0)

Values are presented as number (%) or mean±standard deviation.

^a Major complications include perforation or hemorrhage needing transfusion or endoscopic hemostasis.

Table 3.

Univariable Analysis of Patients' Characteristics Associated with Refractoriness

Variable	Non-refractory (n=14)	Refractory (n=7)	Total (n=21)	p-value
Gender, male	10 (71.4)	7 (100)	17 (81.0)	0.116
Age, years	68.6±6.7	67.2±8.4	68.2±7.2	0.693
Stricture diameter at first dilation				0.799
< 5 mm	2 (14.3)	1 (14.3)	3 (14.3)
6–9 mm	6 (42.9)	2 (28.6)	8 (38.1)
> 10 mm	6 (42.9)	4 (57.1)	10 (47.6)
Stricture length >10 mm	1 (7.1)	3 (42.9)	4 (19.0)	0.049
Focal stricture	1 (7.1)	0 (0)	1 (4.8)	0.469
Last balloon diameter >13.5 mm	9 (64.3)	5 (71.4)	14 (66.7)	0.743
Endoscopic balloon with Bougie dilations	2 (14.3)	5 (71.4)	7 (33.3)	0.009
Total number of dilations (balloon or bougie)	3.11.8	14.2±8.5	6.8±7.6	<0.001
Total number of dilations (balloon)	2.78±1.87	6.29±2.69	3.9±2.69	0.002
Total number of dilations (bougie)	0.29±0.82	8±11.35	2.8±7.2	0.018
Diagnosis date after operation, over 90 days	7 (53.8)	1 (14.3)	8 (40.0)	0.085
Clinical success	12 (85.7)	4 (57.1)	16 (76.2)	0.147
Coronary artery disease	1 (7.1)	0 (0)	1 (4.8)	0.469
Heart failure	2 (14.3)	0 (0)	2 (9.5)	0.293
Diabetes mellitus	0 (0)	2 (28.6)	2 (9.5)	0.035
BMI, body weight (kg)/height (meter)²	16.9±2.63	16.0±1.71	16.6±2.3	0.47
Decreased hemoglobin level after operation, more than 2 g/dL	4 (28.6)	3 (42.9)	7 (33.3)	0.513
Prior chemoradiation	1 (7.1)	0 (0)	1 (4.8)	0.469

Values are presented as number (%) or mean±standard deviation.

BMI, body mass index.

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