Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy

Benign anastomotic stricture after transhiatal oesophagectomy and gastric tube reconstruction constitutes a major problem. From August 1988 to April 1991, 81 patients were followed after cervical oesophagogastrostomy. Twenty-four patients (30 per cent) developed a benign anastomotic stricture 3-23 (median 8) weeks after operation. Poor vascularization of the gastric tube, determined during operation, and postoperative anastomotic leakage were statistically significant risk factors for stricture formation. Symptoms related to stricture were often typical and were confirmed by endoscopy and/or radiography. Radiography did not yield information additional to that obtained from endoscopy. Strictures were treated in the outpatient clinic by dilatation with Savary dilators. Repeated dilatation completely alleviated dysphagia in 20 of the 24 patients (83 per cent). In ten patients dilatations could be discontinued after a median of 8 (range 1-17) sessions. Dilatation was continued until the end of follow-up in nine patients or until death from recurrent disease in five. No complications of dilatation were seen.