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Step-Down Approach for Pharyngoesophageal Corrosive Stricture: Outcome and Analysis

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Abstract

Background

Pharyngoesophageal stricture (PES) is an Achilles’ heel in the management of corrosive injury. Advances in endoscopic techniques were utilized in its management. We classified the stricture as per its dilatability and then planned their treatment.

Methods

PES was sub-categorized based on endoscopic dilatation and availability of cervical oesophagus: group-1 stricture with available cervical oesophagus; group-2 stricture with some part of upper oesophagus made available after endoscopic dilatation and anastomosis in cervico-pharyngeal area; group-3 stricture not amenable for dilatation, anastomosis done at the pharynx. Endoscopic dilatation was performed using through-the-scope pyloric balloon. Number and duration of dilatation sessions before surgery, incidence of tracheostomy, time and incidence for re-stricture and present status of swallowing were evaluated.

Results

Of 226 patients managed, 46 underwent oesophageal replacement for PES. Group 1, 2 and 3 had 12, 14 and 20 patients, respectively. An average 3 (2–4) preoperative balloon dilatation sessions were performed over 6–8 weeks. Tracheostomy was required in 1, 0, 8 patients (p = 0.010), and median hospital stay was 10, 9 and 13 days (p = 0.09) in group 1, 2, 3, respectively. Re-stricture developed in 4/12, 4/14, 9/20 patients with average sessions of dilatation required in post-operative period was 4, 3.5 and 8 in group 1, 2, 3, respectively. >90% of patients are taking normal diet in each group.

Conclusion

We attempted to avoid the high anastomosis by dilating the PES and step down the level of anastomosis in two-third patients. We thereby avoided tracheostomy, aspiration and swallowing problems related to high strictures.

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Acknowledgements

Sundeep S Saluja, Vaibhav K Varshney and P K Mishra contributed in the keeping the data, preparation of manuscript and involved in the management of the patients. Siddharth Srivastava and Pritul Saxena involved in endoscopic management both pre- and post-operatively. Ravi Meher performed hypopharyngoscopy of all patients, adhesiolysis, if needed and involved in patient management.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 1, Jawahar Lal Nehru Marg, New Delhi, 110002, India

    Sundeep Singh Saluja, Vaibhav Kumar Varshney & Pramod Kumar Mishra

  2. Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India

    Siddharth Srivastava & Pritul Saxena

  3. Department of Otorynolaryngology, Lok Nayak Hospital, New Delhi, India

    Ravi Meher

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  1. Sundeep Singh Saluja
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  2. Vaibhav Kumar Varshney
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  3. Pramod Kumar Mishra
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  4. Siddharth Srivastava
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  5. Ravi Meher
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  6. Pritul Saxena
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Correspondence to Sundeep Singh Saluja.

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Saluja, S.S., Varshney, V.K., Mishra, P.K. et al. Step-Down Approach for Pharyngoesophageal Corrosive Stricture: Outcome and Analysis. World J Surg 41, 2053–2061 (2017). https://doi.org/10.1007/s00268-017-3966-y

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  • DOI: https://doi.org/10.1007/s00268-017-3966-y

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