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Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: Gastric pull-up versus colon interposition

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 (2004) In Journal of the American College of Surgeons1994-01-01+01:00 198(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)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the American College of Surgeons1994-01-01+01:00
volume
198
issue
4
pages
536 - 541
publisher
Elsevier Inc.
external identifiers
  • pmid:15051003
  • wos:000220641800006
  • scopus:1842505507
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
2007-10-17 11:54:54
date last changed
2017-12-17 03:25:09
@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 &lt; 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 &lt; 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 Inc.},
  series       = {Journal of the American College of Surgeons1994-01-01+01:00},
  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},
  volume       = {198},
  year         = {2004},
}