Xiao Ma1, Xu Zhang1, Xiao-hui Zhang2

1.2Hospital of Harbin Medical University, Harbin, China,

Background/Aims: Refractory anastomotic strictures (RAS) after esophagectomy are the frequent challenge for the endoscopists. The current therapeutic strategies require repeated sessions of endoscopic therapies but still not maintain long-term patency. We propose a modified incision and cutting method named as Endoscopic Stricturotomy (ES) to treat RAS.

Methods: From Sep.to Dec.2019, 4 patients diagnosed RAS who had undergone more than 3 sessions (3-11 sessions) of endoscopic dilation were enrolled. The steps of ES: one single incision is begun at the anastomotic orifice, and then cutting extended upward in the cephalic direction. The aim of incision is to destroy enough volume of fibrotic tissues with less damaged mucosae. The required length and depth of incision is according to the actual length and thickness of fibrotic tissues. The primary endpoint was the duration of dysphagia relief. The sessions and intervals between endoscopic therapies and complications within 6 months follow-up were counted. The study was approved by local ethic committee.

Results: Dysphagia was relieved in all four patients after ES. The duration of dysphagia relief were 24 weeks (20-32 weeks) during the follow-up. There were 2 patients with persistent reflux esophagitis requested the second ES because of mild dysphagia (grade II) after 8 weeks and the symptoms were completely relieved. There was no failure or complication during following up.

Conclusion: Endoscopic stricturotomy seems to be a good treatment modality for refractory esophageal anastomotic strictures. However, prospective clinical trial with large scale are needed to confirm its utility and place in the management of refractory anastomotic strictures.

Keywords: refractory anastomotic stricture, endoscopic stricturotomy, endoscopic dilation, incision and cutting, dysphagia