Risk Factors for Esophageal Anastomosis Restenosis after Esophageal Dilation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAOChuan , SHENGDong-sheng ,  HUANGNai-xiang

Department of Thoracic Surgery, The 307 th Hospital of Chinese People's Liberation Army, Beijing 100071, P. R. China;

Corresponding author：

HUANGNai-xiang, Email: huangnx6219@sina.com

Keywords：

Esophageal anastomosis stricture; Restenosis; Esophageal dilation; Logistic regression analysis

DOI：

10.7507/1007-4848.20150090

Video：

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Objective To investigate the risk factor for restenosis of esophageal anastomosis stricture after esophageal cancer operation. Methods We retrospectively analyzed the clinical data of 83 patients including 61males and 22 females at age of 58.9(41-81) years with esophageal anastomoic stricture after esophageal cancer operation between January 2002 and December 2013. According to whether the patients developed to restenosis or not, the statistical test and logistic regression was conducted to analyze the risk factors for restenosis. Results In the 83 patients with esophageal anastomoic stricture after esophageal cancer surgery, 35 patients (42.2%) experienced restenosis within the following-up of 1 year. The result of logistic regression analysis indicated that restenosis appeared in 3 months (Wald value=23.3, P < 0.001), the interval between two subsequent sessions of more than 4 weeks at each esophagus dilatation(Wald value=4.8, P=0.029) and the stricture diameter of less than 12 mm after dilation (Wald value=5.8, P=0.016) are the independent risk factors for restenosis in esophageal anastomotic stricture. Conclusion For the patients with esophageal anastomoic stricture after esophageal cancer operation, we believe that it's conducive to reduce esophageal restenosis if the interval between dilations is within 4 weeks and the diameter of stricture after dilation can reach above 12 mm.

Citation： GAOChuan, SHENGDong-sheng, HUANGNai-xiang. Risk Factors for Esophageal Anastomosis Restenosis after Esophageal Dilation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 327-331. doi: 10.7507/1007-4848.20150090 Copy

1.	Lin Y, Totsuka Y, He Y, et al.Epidemiology of esophageal cancer in Japan and China.J Epidemiol, 2013, 23(4):233-242.
2.	程英升, 尚克中, 庄奇新, 等.食管良性狭窄介入治疗方法和再狭窄原因.华人消化杂志, 1998, (09):59-62.
3.	郑永平, 杨壁辉, 郭俊雄, 等.难治性良性食管贲门狭窄扩张术治疗对照研究.中华消化内镜杂志, 2003, 20(4):62-63.
4.	Saeed ZA, WInchester CB, Ferro PS, et al.Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus.Gastrointest Endosc, 1995, 41(3):189-195.
5.	van Heijl M, Gooszen JA, Fockens P, et al.Risk factors for development of benign cervical strictures after esophagectomy.Ann Surg, 2010, 251(6):1064-1069.
6.	Chung WC, Paik CN, Lee KM, et al.The findings influencing restenosis in esophageal anastomotic stricture after endoscopic balloon dilation:restenosis in esophageal anastomotic stricture.Surg Laparosc Endosc Percutan Tech, 2009, 19(4):293-297.
7.	李玫, 林谦, 练敏, 等.胃镜下食管扩张术治疗小儿重度食管狭窄.实用医学杂志, 2011, 27(8):1443-1446.
8.	Standards of Practice Committee, Egan JV, Baron TH, Adler DG, et al.Esophageal dilation.Gastrointest Endosc, 2006, 63(6):755-760.
9.	Saeed ZA, Ramirez FC, Hepps KS, Cole RA, et al.An objective end point for dilation improves outcome of peptic esophageal strictures:a prospective randomized trial.Gastrointest Endosc, 1997, 45(5):354-359.
10.	Michaud L, Gottrand F.Anastomotic strictures:conservative treatment.J Pediatr Gastroenterol Nut, 2011, 52(Suppl 1):S18-S19.
11.	Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology.Role of esophageal stents in benign and malignant diseases.Am J Gastroenterol, 2010, 105(2):258-273.
12.	吴玥, 周雪, 陈瑶, 等.内镜下不同治疗方案对食管吻合口狭窄的疗效分析.第三军医大学学报, 2014, 36(10):1092-1097.
13.	Scolapio JS, Pasha TM, Gostout CJ, et al.A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings.Gastrointest Endosc, 1999, 50(1):13-17.
14.	Barba CA, Butensky MS, Lorenzo M, et al.Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass.Surg Endosc, 2003, 17(3):416-420.
15.	师鹏, 李勇平.影响食管狭窄扩张术疗效的相关因素分析.内蒙古中医药, 2013, 32(18):18-19.
16.	Michaud L, Guimber D, Sfeir R, et al.Anastomotic stenosis after surgical treatment of esophageal atresia:frequency, risk factors and effectiveness of esophageal dilatations.Arch Pediatr, 2001, 8(3):268-274.
17.	Hsu HH, Chen JS, Huang PM, et al.Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial.Eur J Cardiothorac Surg, 2004, 25(6):1097-1101.
18.	Law S, Fok M, Chu KM, et al.Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial.Ann Surg, 1997, 226(2):169.
19.	Sokouti M, Golzari SE, Pezeshkian M, et al.The role of esophagogastric anastomotic technique in decreasingbenign stricture formation in the surgery of esophageal carcinoma.J Cardiovasc Thorac Res, 2013, 5(1):11-16.
20.	Li B, Li YM, Zhang JH, et al.Clinical application of mucosal valve technique for anastomosis during esophagogastrostomy.J Gastrointest Surg, 2013, 17(12):2051-2058.
21.	Blackmon SH, Correa AM, Wynn B, et al.Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis.Ann Thorac Surg, 2007, 83(5):1805-1813.
22.	Law S, Fok M, Chu KM, et al.Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial.Ann Surg, 1997, 226(2):169-173.
23.	钟立哲.食管癌术后食管狭窄形成机制及治疗方法.北华大学学报(自然科学版), 2004, 5(5):434-436.
24.	Cox JG, Winter RK, Maslin SC, et al.Balloon or bougie for dilatation of benign esophageal structure?Dig Dis Sci, 1994, 39(4):776-781.
25.	马佩炯, 李文芳, 郑小青.食管狭窄的诊断与治疗(附沙氏扩张器治疗食管狭窄69例分析).中国医药导报, 2007, (24):31-32.
26.	于奇, 俞张尧, 韩继彪, 等.食管胃吻合口狭窄的扩张治疗.癌症, 1998, 2:52-53.
27.	牟为民, 周淑娟, 刘春雷, 等.食管癌术后吻合口狭窄应用探条扩张器治疗体会.北方药学, 2013, 10(11):115.

1. Lin Y, Totsuka Y, He Y, et al.Epidemiology of esophageal cancer in Japan and China.J Epidemiol, 2013, 23(4):233-242.
2. 程英升, 尚克中, 庄奇新, 等.食管良性狭窄介入治疗方法和再狭窄原因.华人消化杂志, 1998, (09):59-62.
3. 郑永平, 杨壁辉, 郭俊雄, 等.难治性良性食管贲门狭窄扩张术治疗对照研究.中华消化内镜杂志, 2003, 20(4):62-63.
4. Saeed ZA, WInchester CB, Ferro PS, et al.Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus.Gastrointest Endosc, 1995, 41(3):189-195.
5. van Heijl M, Gooszen JA, Fockens P, et al.Risk factors for development of benign cervical strictures after esophagectomy.Ann Surg, 2010, 251(6):1064-1069.
6. Chung WC, Paik CN, Lee KM, et al.The findings influencing restenosis in esophageal anastomotic stricture after endoscopic balloon dilation:restenosis in esophageal anastomotic stricture.Surg Laparosc Endosc Percutan Tech, 2009, 19(4):293-297.
7. 李玫, 林谦, 练敏, 等.胃镜下食管扩张术治疗小儿重度食管狭窄.实用医学杂志, 2011, 27(8):1443-1446.
8. Standards of Practice Committee, Egan JV, Baron TH, Adler DG, et al.Esophageal dilation.Gastrointest Endosc, 2006, 63(6):755-760.
9. Saeed ZA, Ramirez FC, Hepps KS, Cole RA, et al.An objective end point for dilation improves outcome of peptic esophageal strictures:a prospective randomized trial.Gastrointest Endosc, 1997, 45(5):354-359.
10. Michaud L, Gottrand F.Anastomotic strictures:conservative treatment.J Pediatr Gastroenterol Nut, 2011, 52(Suppl 1):S18-S19.
11. Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology.Role of esophageal stents in benign and malignant diseases.Am J Gastroenterol, 2010, 105(2):258-273.
12. 吴玥, 周雪, 陈瑶, 等.内镜下不同治疗方案对食管吻合口狭窄的疗效分析.第三军医大学学报, 2014, 36(10):1092-1097.
13. Scolapio JS, Pasha TM, Gostout CJ, et al.A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings.Gastrointest Endosc, 1999, 50(1):13-17.
14. Barba CA, Butensky MS, Lorenzo M, et al.Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass.Surg Endosc, 2003, 17(3):416-420.
15. 师鹏, 李勇平.影响食管狭窄扩张术疗效的相关因素分析.内蒙古中医药, 2013, 32(18):18-19.
16. Michaud L, Guimber D, Sfeir R, et al.Anastomotic stenosis after surgical treatment of esophageal atresia:frequency, risk factors and effectiveness of esophageal dilatations.Arch Pediatr, 2001, 8(3):268-274.
17. Hsu HH, Chen JS, Huang PM, et al.Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial.Eur J Cardiothorac Surg, 2004, 25(6):1097-1101.
18. Law S, Fok M, Chu KM, et al.Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial.Ann Surg, 1997, 226(2):169.
19. Sokouti M, Golzari SE, Pezeshkian M, et al.The role of esophagogastric anastomotic technique in decreasingbenign stricture formation in the surgery of esophageal carcinoma.J Cardiovasc Thorac Res, 2013, 5(1):11-16.
20. Li B, Li YM, Zhang JH, et al.Clinical application of mucosal valve technique for anastomosis during esophagogastrostomy.J Gastrointest Surg, 2013, 17(12):2051-2058.
21. Blackmon SH, Correa AM, Wynn B, et al.Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis.Ann Thorac Surg, 2007, 83(5):1805-1813.
22. Law S, Fok M, Chu KM, et al.Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial.Ann Surg, 1997, 226(2):169-173.
23. 钟立哲.食管癌术后食管狭窄形成机制及治疗方法.北华大学学报(自然科学版), 2004, 5(5):434-436.
24. Cox JG, Winter RK, Maslin SC, et al.Balloon or bougie for dilatation of benign esophageal structure?Dig Dis Sci, 1994, 39(4):776-781.
25. 马佩炯, 李文芳, 郑小青.食管狭窄的诊断与治疗(附沙氏扩张器治疗食管狭窄69例分析).中国医药导报, 2007, (24):31-32.
26. 于奇, 俞张尧, 韩继彪, 等.食管胃吻合口狭窄的扩张治疗.癌症, 1998, 2:52-53.
27. 牟为民, 周淑娟, 刘春雷, 等.食管癌术后吻合口狭窄应用探条扩张器治疗体会.北方药学, 2013, 10(11):115.

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