The Endoscopic Management of Anastomotic Strictures After Esophagogastric Surgery: A Comprehensive Review of Emerging Approaches Beyond Endoscopic Dilation
Giuseppe Dell’Anna, Jacopo Fanizza, Francesco Vito Mandarino, Alberto Barchi, Ernesto Fasulo, Edoardo Vespa, Lorella Fanti, Francesco Azzolini, Silvia Battaglia, Francesco Puccetti, Andrea Cossu, Ugo Elmore, Antonio Facciorusso, A Dell'Anna, Lorenzo Fuccio, Angelo Bruni, Sara Massironi, Vito Annese, A. Malesci, Gianfranco Donatelli, Riccardo Rosati, Silvio Danese
Abstract
Anastomotic strictures are a common complication following esophagogastric surgery, with prevalence varying depending on the type of surgery and anatomical site. These strictures can lead to debilitating symptoms such as dysphagia, pain, and malabsorption, significantly impacting patients' quality of life. Endoscopic treatment of anastomotic strictures has established a role as the first-line strategy in this setting instead of revision surgery, offering benefits in terms of lower morbidity. Various endoscopic methods are available for anastomotic stricture management, including balloon dilation, stent placement, the new lumen-apposing metal stent, and endoscopic incision techniques. However, there is currently no strong evidence and established guidelines for the optimal treatment strategy. Available data suggest that endoscopic treatments, when performed in tertiary referral centers, can provide favorable outcomes in terms of symptom relief and reduced need for rescue surgical intervention. Nonetheless, challenges remain regarding the management of recurrent strictures and procedural complications, underscoring the need for a personalized, multidisciplinary approach to optimize clinical outcomes. This review aims to provide an updated overview of endoscopic techniques and available evidence with a focus on the most recent technologies, supporting clinicians in effectively managing anastomotic strictures in complex clinical settings.