Benign anastomotic stricture represents a frequent complication after esophagectomy and esophagogastric reconstruction. Some patients had to go through several endoscopic dilations. This study was undertaken to investigate whether early endoscopic examinations after surgery was associated with benign anastomotic stricture development by analyzing morphological change of the anastomosis and gastric tube stump.

Data of 172 patients with early endoscopic examinations following McKeown procedure and gastric tube reconstruction between July 2020 and December 2020 were prospectively collected. Correlations among various potential risk factors including neoadjuvant therapy, adjuvant therapy, severity of mucosal defect and development of benign anastomotic stricture were explored using multivariate logistic analysis.

Fifty patients (29.0%) had developed benign anastomotic stricture with a median of 90 days, requiring a median of 2 endoscopic dilations. No necrosis or leakage at anastomosis or gastric tube stump had ever developed anastomotic strictures. In multivariate analysis, lack of postoperative chemotherapy was the only significant risk factor for BAS (P=0.04). Twenty-nine patients (58.0%) had developed refractory anastomotic strictures. In multivariate analysis, lack of postoperative radiotherapy (P=0.01) and chemotherapy (P=0.03) were the risk factors for refractory anastomotic strictures. Most refractory anastomotic strictures had tendency to develop early after surgery regardless of the adjuvant therapy regimens.

Early postoperative esophagogastric endoscopy is a safe tool that would not increase the incidence of anastomotic necrosis or leakage. Lack of postoperative radiotherapy or chemotherapy was associated with RAS, while asymptomatic mucosal defect had limited predictive value for the occurrence of anastomotic stricture at the anastomotic site and gastric stump.