Endoscopic Dilation for Treatment of Anastomotic Leaks Following Transhiatal Esophagectomy

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Abstract
Background and Study Aims: Anastomotic leak is a known complication after transhiatal esophagectomy (THE) and cervical esophagogastric anastomosis. Conservative management takes a long time to heal such leaks. We assessed the role of endoscopic dilation in patients with anastomotic leak following THE. Patients and Methods: Eight consecutive patients (seven men, one woman; mean age 51) with anastomotic leak following THE were subjected to endoscopic dilation using Savary Gilliard dilators of 7 - 15 mm diameter. The mean interval between surgery and detection of leak was 9 days (range 5 - 22 days) and dilation was performed at a mean interval of 11.4 days (range 1 - 20 days) after detection of the leak. Results: Drainage from fistulas stopped completely after 1 - 8 days (mean 3 days). X-ray with water soluble contrast showed closure of the fistula in all cases. Duration of follow-up ranged from 2 to 12 months. Anastomotic strictures developed in three patients. These patients required three sessions each of repeat dilation, and were alive at follow-up periods of 2, 4, and 12 months, respectively. One patient developed recurrence of growth at an anastomotic site. Four patients died because of distant metastasis. Conclusions: Bougie dilation of anastomotic sites is a safe and effective technique for the healing of anastomotic leaks following THE. However there is a need for a prospective randomized trial comparing endoscopic dilation with no dilation in patients with anastomotic leaks following THE.

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