Electroincision of refractory esophagogastric anastomotic strictures

Most esophagogastric anastomotic strictures can be successfully managed with endoscopic dilation. However, strictures that do not respond to repeated dilation (refractory strictures) are difficult to manage. We report a series of nine patients treated with needle-knife electroincision of symptomatic esophagogastric anastomotic strictures refractory to balloon or Savary dilation. Prior to needle-knife electroincision, the median symptom-free interval between dilations was 13 days; median number of dilations was six (range 3-12). After electroincision, 8/9 patients have experienced a reduction in dysphagia symptoms and a reduced need for endoscopic dilations (follow-up: 90-420 days). No complications occurred. Needle-knife stricturoplasty of refractory esophagogastric anastomotic strictures may produce improved clinical results and may delay or eliminate dysphagia recurrence.