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

• Published in: World journal of surgery 2017-08, Vol.41 (8), p.2053-2061
• Main Authors: Saluja, Sundeep Singh, Varshney, Vaibhav Kumar, Mishra, Pramod Kumar, Srivastava, Siddharth, Meher, Ravi, Saxena, Pritul
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Anastomosis; Anastomotic Stricture; Balloon Dilatation; Balloon treatment; Burns, Chemical - complications; Cardiac Surgery; Caustics - toxicity; Cervical Oesophagus; Child; Constriction, Pathologic - surgery; Deglutition Disorders - surgery; Dilatation - methods; Endoscopic Dilatation; Endoscopy; Esophageal Stenosis - surgery; Esophagus; Female; General Surgery; Group dynamics; Humans; Incidence; Male; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Ostomy; Patients; Pharynx; Pyriform Sinus; Stricture; Surgery; Swallowing; Thoracic Surgery; Tracheostomy; Vascular Surgery; Young Adult
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-3966-y

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.