Effect of Early Endoscopic Evaluation With Balloon Dilatation on Preventing Esophagojejunal Strictures Following Total Gastrectomy for Gastric Cancer

Abstract

Background: The present study aims to evaluate the efficacy of early endoscopic evaluation with balloon dilatation performed during non-symptomatic post-operative period with the intent of preventing benign post-operative esophagojejunal anastomotic strictures in patients who receive total gastrectomy for gastric cancer.

Methods: First, we retrospectively compared the prevalence of benign esophagojejunal anastomotic stricture occurred 1 month after total gastrectomy for gastric cancer in early endoscopic evaluated group using balloon dilatation (n = 61) with non-evaluated group (n = 148); and then we reviewed the relationship between benign anastomotic stricture and other clinicopathological parameters, including gender, age, body mass index (BMI), and tumor, node, metastasis (TNM) stage.

Results: The total number of patients was 209, with 139 men and 70 women, and with an average age of 57.8 years. The endoscopic evaluation with or without balloon dilatation on the 10th post-operative day (POD) was performed in 61 out of 209 patients. Of them, benign post-operative anastomotic stricture was found in 17 patients (27.9%). In the remaining 148 patients, benign post-operative anastomotic stricture occurred in 14 (9.5%) patients. In the 61 patients who received early endoscopic evaluation, 16 received preventive balloon dilatation at the same time and four of them showed benign stricture (4/16, 25%). Of the remaining 45 patients who was endoscopically evaluated without balloon dilatation, 13 had benign strictures (13/45, 28.9%). Preventive endoscopic balloon dilatation (EBD) on the 10th POD was not statistically related to post-operative stricture in a total of 209 patients (P = 0.260) and in early gastrofiberscopy (GFS) sub-group (P = 1.000). A multivariable logistic regression analysis showed that pre-operative BMI (P = 0.014) and endoscopy on the 10th POD (P = 0.001) were independent predictors of post-operative anastomotic stricture.

Conclusions: Endoscopic procedure with balloon dilatation, which we had expected to prevent stenosis by widening the internal diameter of the anastomosis site in early post-operative period after total gastrectomy, does not prevent stenosis but rather promotes post-operative stricture. In addition, the lower the pre-operative BMI is, the more frequent post-operative benign anastomotic stricture will be.




J Curr Surg. 2019;9(1):1-5
doi: https://doi.org/10.14740/jcs370