Predictive value of early postoperative esophagoscopy for occurrence of benign stenosis after cervical esophagogastrostomy

Background and Study Aims: Benign anastomotic stenosis (BAS) represents a frequent complication following esophagectomy and cervical esophagogastrostomy for cancer. This study was undertaken to evaluate through early postoperative esophagoscopy the morphologic change of the anastomosis which could be related to BAS development. Patients and Methods: Thirty-nine patients who underwent subtotal esophagectomy and cervical esophagogastrostomy were prospectively evaluated. The analyzed factors were: age; sex; the anastomotic size; the presence and number of endoscopically visible stitches; the presence and percentage of mucosal ulcerations involving the anastomotic suture line; the presence of anastomotic leak or dehiscence; the vascularization of the gastric tube; the patency of pylorus. Results: No complications related to the early esophagoscopy were observed. Twelve patients (30.7%) developed a stenosis postoperatively. The univariate analysis demonstrated anastomotic leak (p<0.006), more than one endoscopically visible stitch (p<0.0003), and mucosal ulceration involving more than 50% of the anastomosis (p<0.00009) as factors significantly correlated with BAS development. How ever stepwise logistic regression extracted the presence of ulcerations involving more than 50% of the anastomosis as the most important independent factor in prediciting BAS development (Odds Ratio = 9.03 +/- 5.5, p = 0.009). All patients who developed a BAS were treated with early pneumatic dilatations, with an 83.3% success rate after a mean of 3.6 sessions. Conclusions: Early postoperative esophagoscopy seems a safe and effective tool for the monitoring of the anastomosis healing after cervical esophagogastrostomy. The presence of extended mucosal ulcerations appeared as the most important factor in predicting BAS formation.