# The Impact of Endoscopic Dilatation in Post-Esophagectomy Anastomotic Stricture: Risk Factors and Treatment Outcomes

## TL;DR

This study examines how endoscopic dilatation treats post-esophagectomy strictures, finding that refractory cases require more sessions and have worse outcomes.

## Contribution

The study identifies procedural indicators of refractory strictures and highlights the need for tailored treatment strategies.

## Key findings

- Refractory strictures required significantly more dilatation sessions and had smaller maximum dilator sizes achieved.
- Clinical success after the first session was lower in refractory cases, and stent placement was more frequent.
- No significant associations were found between stricture type and demographic variables or surgical approach.

## Abstract

Background: Benign anastomotic strictures are a common complication after esophagectomy, contributing significantly to postoperative morbidity and reduced quality of life. Endoscopic dilatation is the primary treatment modality; however, a subset of patients develop refractory strictures that require repeated interventions and pose unique therapeutic challenges.

Objectives: To evaluate the clinical impact of endoscopic dilatation in patients with post-esophagectomy strictures and to identify procedural and clinical indicators associated with stricture refractoriness.

Methods: This retrospective observational study analyzed 69 patients who developed benign anastomotic strictures after esophagectomy and underwent endoscopic dilatation at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore, Pakistan between January 2019 and December 2023. Patients were categorized as having recurrent (n = 61) or refractory strictures (n = 8) based on response to treatment. Demographics, procedural variables, and outcomes were assessed using Statistical Package for the Social Sciences (SPSS) version 25, with statistical significance set at p < 0.05.

Results: Refractory strictures accounted for 7(11.6%) of cases and were associated with a significantly higher number of dilatation sessions (mean 12.25 vs. 4.70; p < 0.001), smaller maximum dilator sizes achieved (12.63 mm vs. 13.77 mm; p = 0.002), and earlier onset of symptoms requiring intervention (3.5 vs. 5.46 months post-surgery; p = 0.033). Clinical success after the first session was significantly lower in refractory cases 53 (87.5%) vs. 100 (100%); p = 0.005), and stent placement was markedly more frequent 53(87.5%) vs. 15 (24.6%); p < 0.001). No statistically significant associations were found between stricture type and demographic variables, tumor staging, or surgical approach.

Conclusion: Endoscopic dilatation is highly effective for managing recurrent post-esophagectomy strictures. However, refractory strictures represent a more aggressive phenotype, characterized by earlier onset, a poor response to initial therapy, and a greater procedural burden. Early identification through procedural indicators, combined with tailored interventional strategies including early stent placement and adjunctive therapies is essential for improving outcomes in this challenging patient subgroup.