The Influence Factors Of Anastomotic Stricture Formation After Resection Of Esophageal Carcinoma And The Therapy Of Endoscopic Balloon Dilation

Objective: To investigate the influence factors of anastomotic stricture formation after resection of esophageal carcinoma and to evaluate the theraputic efficacy of endoscopic balloon dilation in patients with anastomotic stricture .Methods: To retrospective analyse the clinical data of patients with carcinoma of the esophagus which were operated in our hospital from January 2005 to May 2007. All the informations such as the age ,sex of the patients; the location, pathology, lenth of the lesions, the staging, the course of the disease, the method and complications of operations and the therapy of postoperation were collected and statistical analysed with the multiple logistic regression analysis. In our center of endoscopy, balloon dilation under endoscopies was performed in 39 out-patients with benign anastomotic stenosis who had undergone esophagectomy due to their malignancies. All patients were followed up for their symptoms, life quality and surviving times, and were regularly examined by endoscopies and esophageal lipiodol radiography.Results: Excluding the two patients with malignant stricture caused by the anastomotic recurrent carcinoma, benign anastomotic stenosis occurred in 11 cases (9.82%, n=112). Median time to the presentation of anastomotic stricture was 2.5 months (range 1.0-27 months), A statistically significant correlation was found with modus of anastomosis (P=0.022) and correlated inflammation at Stoma site (P=0.004) by analysed with the Logistic regression. They were risk factors influencing on anastomotic stricture formation. 97 times endoscopic balloon dilations were performed in 39 out-patients with benign anastomotic stenosis. Average 2.5 times operations were performed in each patient. The dysphagia in short term was completely released in 100%. The average diameter of stoma was extended significantly from 0.42 cm to 2.11 cm after the therapy ( P < 0.001). There was no serious complications occurring except membrana mucosa split and a small quantity errhysis in all cases. Single balloon dilation were performed in 18 cases . two times balloon dilation were performed in 7 cases. Three times balloon dilation were performed in 9 cases. More than four times balloon dilation were performed in 5 cases. Effective rate was 97.4%(38/39), excellence rate was 51.28%(20/39). The efficacy was affected by the location of stoma, the primary diameter and length of stenosis, the times of dilation, the time of dilation and correlated inflammation at Stoma site. The cancer recurrented after the dilation in 5 cases and stents were placed in 3 patients because of the esophageal stircture.Conclusion: Modus of anastomosis and correlated inflammation at Stoma site are independent risk factors influencing on anastomotic stricture formation after resection of esophageal cancer. Balloon dilation under endoscopies is a very effective method for the treatment of benign anastomosis stenosis followed by esophagectomy. The efficacy was possiblely affected by the location of stom, the primary diameter and length of stenosis, the times of dilation, the time of dilation and correlated inflammation at Stoma site. Being simple, safe, reliable and repeatabilable, balloon dilation could be the first choice of the treatment of esophageal anastomosis strictures.