Balloon dilatation of strictured cervical anastomosis after subtotal esophagus resection

Aims: One of the most common complications of subtotal esophagus resection are the stricture of the cervical esophago-gastrostomy, the esophago-colostomy or the esophago-ileostomy. The authors analysed the causes of the stricture and the early results of their balloon dilatation therapy.

Patients and methods: In a 5 year period after subtotal esophagus resection 26 patients (22 male, 4 female, mean age of 53.7 years) were treated 62 times with balloon dilatation of the cervical anastomosis. The strictures of the anastomoses that required investigation developed after esophago-gastrostomy in 20 patients, after esophago-colostomy in 1 patient, after esophago-ileostomy in 1 patient and after pharingo-gastrostomy in 3 patients. Partial insufficiency of the anastomosis was found previously in only 7 cases (25%). The mean period between the surgery and the balloon dilatation was 7.82 (1–52) months. In four cases the origin of the stricture was tumour reccurence.

Results: There was no complication relating to the intervention. The mean number of the dilatations was 28 in the patients with leakage of the anastomosis and 24 in patients without it. In four patients having tumour reccurence the number of dilatation was 1–1, 9 and 8. In these patients stent was inserted in the strictured anastomosis. The balloon dilatation was succesful in all cases, the quality of swallow got better.

Conclusion: In experienced hand the balloon dilatation of the strictured cervical anastomosis after subtotal esophagus resection is safe and succesful method. In this series there was no relation between the number of dilatations and the previous insufficiency of the anastomosis. The authors suggest the early and “agressive“ balloon dilatation of these strictured anastomoses.