Endoscopic dilation for treatment of anastomotic leaks following transhiatal esophagectomy

Background and Study Aims: Anastomotic leak is a known complication after t ranshiatal esophagectomy (THE) and cervical esophagogastric anastomosis. Co nservative management takes a long time to heal such leaks, We assessed the role of endoscopic dilation in patients with anastomotic leak following TH E. Patients and Methods: Eight consecutive patients (seven men, one woman; mea n age 51) with anastomotic leak following THE were subjected to endoscopic dilation using Savary Gilliard dilators of 7-15 mm diameter. The mean inter val 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) af ter detection of the leak. Results: Drainage from fistulas stopped completely after 1-8 days (mean 3 d ays). X-ray with water soluble contrast showed closure of the fistula in al l cases, Duration of follow-up ranged from 2 to 12 months, Anastomotic stri ctures developed in three patients, These patients required three sessions each of repeat dilation, and were alive at follow-up periods of 2, 4, and 1 2 months, respectively. One patient developed recurrence of growth at an an astomotic site. Four patients died because of distant metastasis. Conclusions: Bougie dilation of anastomotic sites is a safe and effective t echnique 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.