Going with the Flowmetry: How Doppler Assessment Helps Predict the Formation of Anastomotic Strictures After Esophagectomy

Excerpt

Esophageal cancer is the eighth most common cancer worldwide, with squamous cell carcinoma representing the majority of cases. Over the past 10–20 years, however, there have been a vastly increasing number of adenocarcinoma cases [1]. An esophagogastrectomy with creation of a gastric conduit and an esophago-gastric anastomosis is the most common surgical treatment for patients with early-stage esophageal cancer without evidence of distant metastatic disease [2]. The area of the anastomosis between the esophagus and the stomach is the source of significant morbidity in terms of both anastomotic leaks and postoperative stricture formation [3]. Postoperative stricture formation has a reported incidence of 26–42% and is of significant detriment to patients’ quality of life [4]. Prior studies have surmised that the source of leaks and strictures at the anastomosis is due to the relative ischemia of the tip of the gastric conduit, which solely relies on the right gastroepiploic artery for its blood supply [4]. This ischemia hypothesis is based on body mass index (BMI) and cardiovascular disease as both represent independent risk factors for stricture formation and were felt to be surrogate markers of poor vasculature condition in the gastric conduit [4]. In this issue of Digestive Diseases and Sciences, Wang et al. [5] provide convincing diagnostic evidence to support the hypothesis that local tissue ischemia in the gastric conduit is associated with an increased incidence of anastomotic strictures. The significance of this finding, especially if determined to be a modifiable risk factor, would be to reduce a substantial source of morbidity and the need for additional invasive procedures in this population. …