Histological Predictors of Anastomotic Stenosis in Esophageal Substitution Surgery

Objective: To evaluate histopathological markers of inflammation and tissue repair in esophageal specimens obtained during substitution surgery and determine their association with postoperative anastomotic stenosis.Design: Retrospective cross-sectional study.Setting: Tertiary care referral center (Clínica de Tracto Digestivo Superior, Hospital General de México "Dr. Eduardo Liceaga").Participants: Sixteen adults undergoing esophageal substitution for benign disease between January 2012 and January 2022. Inclusion required complete clinical records and native esophageal histology; cases with malignancy or missing histology were excluded.Methods: Archived slides from the proximal esophageal margin were reviewed with hematoxylin and eosin and Masson's trichrome. A semi-quantitative score assessed neutrophilic infiltration, lymphocytic infiltration, collagen deposition, and granulation tissue across mucosa, submucosa, and muscularis (range 0-18), classifying profiles as low risk (≤15) or high risk (≥16). Patients were grouped by presence (CEA) or absence (SEA) of postoperative stenosis. Statistical comparisons used Fisher's exact test and Mann-Whitney U, with medians (IQR) and exact p-values.Results: Median total histological scores were higher in CEA than SEA (18 [17-18] vs 12 [9-15]; P=0.014). All stenosis cases were high-risk, whereas 92.3% of non-stenosis cases were low-risk (P=0.007). Individual inflammatory markers were not statistically different between groups; however, collagen deposition and granulation tissue appeared more severe among CEA patients. No meaningful differences in demographic or operative variables were observed.Conclusion: In this exploratory study, a composite histopathological score identified patients at increased risk of postoperative anastomotic stenosis. The approach may support risk stratification and surveillance in gastrointestinal reconstructive surgery and warrants external validation.