Surgery Effective for Corrosive Strictures of the Esophagus

A new study reports that surgical management is a successful option for patients with corrosive strictures of the esophagus.

Researchers at the All India Institute of Medical Sciences (New Delhi) conducted a retrospective analysis of 176 patients with corrosive strictures of the esophagus that were managed surgically between 1983 and 2009, either by resection (64 patients) or bypass of the damaged esophagus and replacement by a conduit (112 patients). Follow up of more than 10 years was available for 44.3%, and more than 15 years for 30.7% of the patients. The type of surgery performed, the conduit used, and the short- and long-term outcomes were assessed.

The results showed that there were no differences in the short- or long-term outcomes between groups, but the mean duration of surgery, intraoperative blood loss, incidence of conduit necrosis, and in-hospital mortality was significantly lower in patients with stomach conduits, as compared with colonic conduits. There was a higher incidence of recurrent laryngeal nerve palsy, recurrent dysphagia, and aspiration after surgery in patients with strictures involving the upper end of the esophagus at or near the hypopharynx. Complications included cervical anastomotic leaks in 22 patients (all of which were managed nonoperatively), conduit necrosis in eight patients (all addressed with re-exploration and surgery), and postoperative death in 11 patients. The study was published early online on March 2, 2011, in Annals of Surgery.

"The use of the stomach avoided the extra anastomosis required with colonic conduits and thus decreased anastomotic leaks, which occurred in seven patients in whom the colon was used,” concluded lead author Amit Javed, MD, and colleagues of the department of gastrointestinal surgery. "We therefore believe that the stomach should be used as the conduit of choice in patients of corrosive stricture of the esophagus with a normal stomach.”

An esophageal stricture is a gradual narrowing of the esophagus caused by scar tissue build up. This can occur due to chronic exposure of the esophagus to gastric contents, which accounts for approximately 60%-70% of cases. Other etiologies include esophageal webs, radiation injuries, caustic ingestions, photodynamic therapy-induced strictures, and anastomotic strictures. In time, as this scar tissue continues to build up, the esophagus begins to stiffen and narrow in that area, resulting in swallowing difficulties.

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All India Institute of Medical Sciences