Endoscopic incisional therapy for benign anastomotic strictures after esophagectomy or gastrectomy: a systematic review and meta-analysis

Zaharadeen Jimoh; Uzair Jogiat; Alex Hajjar; Kevin Verhoeff; Simon Turner; Clarence Wong; Janice Y Kung; Eric L R Bédard

doi:10.1007/s00464-024-10817-8

Endoscopic incisional therapy for benign anastomotic strictures after esophagectomy or gastrectomy: a systematic review and meta-analysis

Surg Endosc. 2024 Apr 22. doi: 10.1007/s00464-024-10817-8. Online ahead of print.

Authors

Zaharadeen Jimoh¹, Uzair Jogiat^{2

3}, Alex Hajjar⁴, Kevin Verhoeff⁴, Simon Turner⁴, Clarence Wong⁵, Janice Y Kung⁶, Eric L R Bédard⁴

Affiliations

¹ Faculty of Nursing, University of Alberta, Edmonton, Canada.
² Division of Thoracic Surgery, Univesity of Alberta, Edmonton, AB, Canada. ujogiat@ualberta.ca.
³ Division of General Surgery, Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Center, 8440-112 St NW, Edmonton, AB, T6G2B7, Canada. ujogiat@ualberta.ca.
⁴ Division of Thoracic Surgery, Univesity of Alberta, Edmonton, AB, Canada.
⁵ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, Canada.

PMID: 38649492
DOI: 10.1007/s00464-024-10817-8

Abstract

Background: Studies have evaluated the efficacy of endoscopic incisional therapy (EIT) for benign anastomotic strictures. We performed a systematic review and meta-analysis to evaluate stricture recurrence after EIT following esophagectomy or gastrectomy.

Methods: A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel-Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test.

Results: A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13-0.92, p = 0.03; I² = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17-0.59, p = 0.0003; I² = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12-3.28, p = 0.58; I² = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41-73.11, p = 0.006) among patients undergoing EIT compared to dilation.

Conclusion: Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures.

Keywords: Anastomotic strictures; Dilation; Endoscopic incisional therapy; Esophagectomy; Gastrectomy.

Publication types

Review