Effective diameter of balloon dilation for benign esophagojejunal anastomotic stricture after total gastrectomy

Abstract

BackgroundBenign strictures at esophagojejunostomy sites may develop after total gastrectomy, and through-the-scope balloon dilation
(TTS-BD) can relieve them. The aim of this study was to evaluate effective and safe balloon diameter for benign stricture
after total gastrectomy.

MethodsFrom June 2001 to December 2006, 930 gastric cancer patients underwent total gastrectomy with Roux-en-Y esophagojejunostomy
in a cancer center hospital. We performed TTS-BD when benign strictures developed. Initial success rate, complication rate,
and restenosis rate were evaluated. We classified the patients into three groups according to final dilation diameter and
number of sessions.

ResultsA total of 58 patients (6.2%) developed a benign stricture at the esophagojejunostomy site. We classified them into three
groups based on the final luminal diameter of the balloon used and the number of sessions, as follows: group A (n=20), 13.5–15mm in one or two sessions; group B (n=13), 16.5–20mm in one session; group C (n=25), 16.5–20mm in two sessions. The initial success rates were 100% for groups A and B and 96% for group C. A perforation
occurred in one patient (7.7%) in group B. Restenosis occurred in two patients (10%) in group A, one patient (7.7%) in group
B, and in no patients in group C (p=0.29). Restenosis was resolved by one or two further TTS-BDs.

ConclusionTTS-BD to 15mm was a safe and effective treatment for benign esophagojejunostomy strictures following total gastrectomy.
Restenosis was not common and could be resolved by one or two further TTS-BD sessions.