Endoscopic Treatment of Postoperative Esophageal Anastomotic Strictures: A Single Center Experience

Öz

Background To evaluate the analysis, treatment methods and results of endoscopic treatments of esophagojejunostomy (EJ) and esophagogastric (EG) anastomotic strictures. Methods: Data from patients treated between 2009 and 2019 was collected and analyzed. The primary endpoint was defined as the absence of dysphagia for at least 6 months after the final endoscopic treatment session. The improvement in dysphagia scores at 1 and 6 months was accepted as the secondary endpoint. Results Of 18 patients (10 male), there were 11 patients with EG anastomotic stricture and 7 patients with EJ anastomotic stricture. Only balloon or bougie dilatation was applied to 13 patients, while 5 patients received a full-covered metal stent (FCMS) in addition to balloon or bougie dilatation due to persistent dysphagia symptoms. The primary endpoint was reached in 10 of the 13 patients (76.9%) who received only balloon or bougie dilatation. The secondary endpoint was reached in 3 patients. The primary endpoint was reached in 4 of the 5 patients (80%) who received a FCMS in addition to balloon or bougie dilatation. 6 patients (33.3%) had a recurrence. Major complications occurred in 4 (22.2%) patients, including perforation in 2 and stent migration in 2 patients. Conclusion The study demonstrated that endoscopic treatment of esophageal anastomotic strictures is a reliable and effective treatment option with a high success rate. The use of FCMS, either as a primary treatment option or in the treatment of perforation as a complication of endoscopic treatment, showed good effectiveness in our study.

Anahtar Kelimeler

• Esophagojejunostomy
• Esophagogastric
• Anastomotic stricture
• Full-covered metal stent

Postoperatif Özofageal Anastomoz Darlıklarının Endoskopik Tedavisi: Tek Merkez Deneyimi

Öz

Giriş Özofagojejunostomi ve özofagogastrik anastomoz darlıklarının endoskopik tedavilerinin analizi, tedavi yöntemleri ve sonuçlarının değerlendirilmesi. Yöntem 2009 ve 2019 yılları arasında endoskopik olarak tedavi edilen hastaların verileri toplandı ve analiz edildi. Primer sonlanım noktası, son endoskopik tedavi seansından sonra en az 6 ay süreyle disfaji olmaması olarak tanımlandı. 1. ve 6. aylarda disfaji skorlarındaki iyileşme ikincil sonlanım noktası olarak kabul edildi. Sonuçlar 18 hastanın (10 erkek) 11'inde özofagogastrik anastomoz darlığı, 7'sinde Özofagojejunostomi anastomoz darlığı vardı. 13 hastaya sadece balon veya buji dilatasyonu uygulanırken, 5 hastaya devam eden disfaji semptomları nedeniyle balon veya buji dilatasyonuna ek olarak tam kaplı metal stent uygulandı. Sadece balon veya buji dilatasyonu uygulanan 13 hastanın 10'unda (%76.9) primer sonlanım noktasına ulaşıldı. İkincil sonlanım noktasına 3 hastada ulaşıldı. Balon veya buji dilatasyonuna ek olarak tam kaplı metal stent uygulanan 5 hastanın 4'ünde (%80) primer sonlanım noktasına ulaşıldı. 6 hastada (%33.3) nüks görüldü. 2 hastada perforasyon ve 2 hastada stent migrasyonu olmak üzere 4 (%22,2) hastada majör komplikasyon gelişti. Sonuç Çalışmamız, özofagus anastomoz darlıklarının endoskopik tedavisinin yüksek başarı oranı ile güvenilir ve etkili bir tedavi seçeneği olduğunu göstermiştir. Tam kaplı metal stentin hem primer tedavi seçeneği olarak hem de endoskopik tedavinin bir komplikasyonu olarak perforasyon tedavisinde kullanılması çalışmamızda iyi etkinlik göstermiştir.

Anahtar Kelimeler

• Özofagojejunostomi,
• özofagogastrik,
• anastomoz darlığı,
• tam kaplı metal stent

Kaynakça

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