Operative management of a difficult problem: Cervical esophagogastric anastomotic stricture

Abstract

Cervical esophagogastric anastomotic stricture is a vexing problem both for the patient and the treating surgeon. Given the location of the anastomosis at the thoracic inlet and its proximity to vocal cords and upper esophageal sphincter, management of such a stricture can be challenging. In this comprehensive review, we will first discuss the various endoscopic options that are available for the management of such strictures such as dilation, topical injections, electrocautery incision, and stenting. However, the focus of our chapter is to discuss surgical options for those patients who develop strictures or fistulae that are refractory to endoscopic management and require operative intervention. Surgical options including cervical esophageal reconstruction such as strictureplasty and myocutaneous flaps, as well as alternative conduits will therefore be highlighted. Finally, we will discuss and review the data that potentially explains how to avoid such anastomotic strictures.