The Impact of Endoscopic Dilatation in Post-Esophagectomy Anastomotic Stricture: Risk Factors and Treatment Outcomes

Benign anastomotic strictures are a common complication after esophagectomy, contributing significantly to postoperative morbidity and reduced quality of life. Endoscopic dilatation is the primary treatment modality; however, a subset of patients develop refractory strictures that require repeated interventions and pose unique therapeutic challenges.

To evaluate the clinical impact of endoscopic dilatation in patients with post-esophagectomy strictures and to identify procedural and clinical indicators associated with stricture refractoriness.

This retrospective observational study analyzed 69 patients who developed benign anastomotic strictures after esophagectomy and underwent endoscopic dilatation at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore, Pakistan between January 2019 and December 2023. Patients were categorized as having recurrent (n = 61) or refractory strictures (n = 8) based on response to treatment. Demographics, procedural variables, and outcomes were assessed using Statistical Package for the Social Sciences (SPSS) version 25, with statistical significance set at p < 0.05.

Refractory strictures accounted for 7(11.6%) of cases and were associated with a significantly higher number of dilatation sessions (mean 12.25 vs. 4.70; p < 0.001), smaller maximum dilator sizes achieved (12.63 mm vs. 13.77 mm; p = 0.002), and earlier onset of symptoms requiring intervention (3.5 vs. 5.46 months post-surgery; p = 0.033). Clinical success after the first session was significantly lower in refractory cases 53 (87.5%) vs. 100 (100%); p = 0.005), and stent placement was markedly more frequent 53(87.5%) vs. 15 (24.6%); p < 0.001). No statistically significant associations were found between stricture type and demographic variables, tumor staging, or surgical approach.

Endoscopic dilatation is highly effective for managing recurrent post-esophagectomy strictures. However, refractory strictures represent a more aggressive phenotype, characterized by earlier onset, a poor response to initial therapy, and a greater procedural burden. Early identification through procedural indicators, combined with tailored interventional strategies including early stent placement and adjunctive therapies is essential for improving outcomes in this challenging patient subgroup.