Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: Gastric pull-up versus colon interposition
(2004) In Journal of the American College of Surgeons 198(4). p.536-541- Abstract
- BACKGROUND: Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. STUDY DESIGN: Three hundred ninety-three consecutive esophagectomy patients had prevalence and risk factors determined for graft ischemia and anastomotic leak; 363 of these patients followed for more than I month (median 15 months) had prevalence and risk factors determined for anastomotic stricture. RESULTS: Conduit ischemia occurred in 36 (9.2%) and anastomotic leak in 43 patients (10.9%). Risk factor for ischemia was comorbid conditions requiring therapy (Odds ratio [OR]: 2.2 [95% CI 1.1-4.3]), and for leak were ischemia... (More)
- BACKGROUND: Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. STUDY DESIGN: Three hundred ninety-three consecutive esophagectomy patients had prevalence and risk factors determined for graft ischemia and anastomotic leak; 363 of these patients followed for more than I month (median 15 months) had prevalence and risk factors determined for anastomotic stricture. RESULTS: Conduit ischemia occurred in 36 (9.2%) and anastomotic leak in 43 patients (10.9%). Risk factor for ischemia was comorbid conditions requiring therapy (Odds ratio [OR]: 2.2 [95% CI 1.1-4.3]), and for leak were ischemia (OR: 5.5 [95% CI 2.5-12. 1]), neoadjuvant therapy (OR: 2.2 [95% CI 1.1-4-5]), and comorbid conditions (OR: 2.1 [95% Cl 1.1-3.9]). A stricture developed in 80 patients (22.0%). Risk factors were ischemia (OR: 4.4 [95% Cl 2.0-9.6]), anastomotic leak (OR: 3.8 [95% C11.9-7.6]), and increasing preoperative weight (p = 0.022). The prevalence of ischemia was similar after gastric (10.4%) versus colonic (7.4%) reconstruction; leak and stricture were more common (14.3% versus 6.1%, p = 0.013, 31.3% versus 8.7%, p < 0.000 1, respectively) and strictures were more severe (11.2% versus 2%, p = 0.00 1) after gastric pull-up. Patients free of ischemia and leak who developed stricture were more likely to have had a gastric pull-up (25% versus 7%, p < 0. 000 1). Dilatation was effective treatment in 93% of patients. CONCLUSIONS: After esophagectomy 10% of patients will develop conduit ischemia or an anastomotic leak and 22% will develop anastornotic stricture. Anastomotic leak and strictures are more common and the strictures are more severe after gastric pull-up compared with colon interposition. Dilatation is a safe and effective treatment. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/281777
- author
- Briel, J W ; Tamhankar, A P ; Hagen, J A ; DeMeester, S R ; Johansson, Jan LU ; Choustoulakis, E ; Peters, J H ; Bremner, C G and DeMeester, T R
- organization
- publishing date
- 2004
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of the American College of Surgeons
- volume
- 198
- issue
- 4
- pages
- 536 - 541
- publisher
- Elsevier
- external identifiers
-
- pmid:15051003
- wos:000220641800006
- scopus:1842505507
- pmid:15051003
- ISSN
- 1879-1190
- DOI
- 10.1016/j.jamcollsurg.2003.11.026
- language
- English
- LU publication?
- yes
- id
- 68603d37-684d-4cd3-8bca-572ec7a5c05a (old id 281777)
- date added to LUP
- 2016-04-01 12:02:04
- date last changed
- 2022-03-05 17:55:03
@article{68603d37-684d-4cd3-8bca-572ec7a5c05a,
abstract = {{BACKGROUND: Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. STUDY DESIGN: Three hundred ninety-three consecutive esophagectomy patients had prevalence and risk factors determined for graft ischemia and anastomotic leak; 363 of these patients followed for more than I month (median 15 months) had prevalence and risk factors determined for anastomotic stricture. RESULTS: Conduit ischemia occurred in 36 (9.2%) and anastomotic leak in 43 patients (10.9%). Risk factor for ischemia was comorbid conditions requiring therapy (Odds ratio [OR]: 2.2 [95% CI 1.1-4.3]), and for leak were ischemia (OR: 5.5 [95% CI 2.5-12. 1]), neoadjuvant therapy (OR: 2.2 [95% CI 1.1-4-5]), and comorbid conditions (OR: 2.1 [95% Cl 1.1-3.9]). A stricture developed in 80 patients (22.0%). Risk factors were ischemia (OR: 4.4 [95% Cl 2.0-9.6]), anastomotic leak (OR: 3.8 [95% C11.9-7.6]), and increasing preoperative weight (p = 0.022). The prevalence of ischemia was similar after gastric (10.4%) versus colonic (7.4%) reconstruction; leak and stricture were more common (14.3% versus 6.1%, p = 0.013, 31.3% versus 8.7%, p < 0.000 1, respectively) and strictures were more severe (11.2% versus 2%, p = 0.00 1) after gastric pull-up. Patients free of ischemia and leak who developed stricture were more likely to have had a gastric pull-up (25% versus 7%, p < 0. 000 1). Dilatation was effective treatment in 93% of patients. CONCLUSIONS: After esophagectomy 10% of patients will develop conduit ischemia or an anastomotic leak and 22% will develop anastornotic stricture. Anastomotic leak and strictures are more common and the strictures are more severe after gastric pull-up compared with colon interposition. Dilatation is a safe and effective treatment.}},
author = {{Briel, J W and Tamhankar, A P and Hagen, J A and DeMeester, S R and Johansson, Jan and Choustoulakis, E and Peters, J H and Bremner, C G and DeMeester, T R}},
issn = {{1879-1190}},
language = {{eng}},
number = {{4}},
pages = {{536--541}},
publisher = {{Elsevier}},
series = {{Journal of the American College of Surgeons}},
title = {{Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: Gastric pull-up versus colon interposition}},
url = {{http://dx.doi.org/10.1016/j.jamcollsurg.2003.11.026}},
doi = {{10.1016/j.jamcollsurg.2003.11.026}},
volume = {{198}},
year = {{2004}},
}