Cryoablation for Benign Gastrointestinal Anastomotic Strictures

A Randomized Controlled Trial of Cryotherapy on Benign Anastomotic Strictures Following Esophagectomy, Gastrectomy, and Bariatric Surgery

Anastomotic stricture is a common complication following foregut surgery. The standard of care for these benign foregut anastomotic strictures is balloon dilatation. However, re-stenosis of strictures is also common, requiring frequent repetition of balloon dilatation. Cryotherapy is a novel therapy that may improve clinical outcomes following dilatation. The purpose of the present study is to conduct a randomized controlled trial to characterize the impact of cryotherapy on clinical outcomes and complications for benign anastomotic strictures following esophagectomy, gastrectomy, and bariatric surgery.

Esophageal Stricture, Duodenal Stricture, Jejunal Stricture, Anastomotic Stricture of Small Intestine

Cryotherapy entails introducing a 9 French catheter via the endoscope's accessory port. The catheter is advanced until it is visualized on the endoscopy monitor. Under 4 psi pressure, liquid nitrogen is sprayed from the catheter for twenty seconds over each four-centimeter segment of stricture

This procedure entails deploying a balloon via the accessory port of the esophagogastroduodenoscope under direct visualization and serially inflating the balloon. Balloon dilatation disrupts not only the muscular rings surrounding strictures but also the granulation tissue composing the strictures.

Inclusion Critieria History of esophagectomywith primary anastomosis History of gastrectomy with primary anastomosis History of bariatric surgery with primary anastomosis History of anastomotic stricture History of balloon dilatation at Keck Hospital of the University of Southern California Exclusion Critieria Patients treated at medical centers other than Keck Hospital of the University of Southern California History of anastomotic stent placement