A Case of Early Gastric Tube Stenosis after Esophageal Cancer Resection Resolved by Temporary Placement of a Removable Self-expandable Metallic Stent

Abstract

A 76-year-old man was diagnosed with cancer of the lower thoracic esophagus and underwent neoadjuvant chemotherapy with DCF regimen followed by thoraco-laparoscopic subtotal thoracic esophagectomy. As for esophageal reconstruction, we used a gastric tube anastomosed to the cervical esophagus via retrosternal route. He had neither postoperative recurrent laryngeal nerve paralysis nor a problem with swallowing, so that oral ingestion was initiated on the 7^th postoperative day. He vomited on the 9^th postoperative day when a chest X-ray film revealed dilatation of the gastric tube. Insertion of a nasogastric tube led to symptomatic remission, but the gastric tube dilatation recurred after removal of the nasogastric tube. Since no twisting of the gastric tube was revealed on CT, we diagnosed that the tube might have bent causing the dilatation. His symptom was resolved by temporary placement of a self-expandable metallic stent (SEMS) and he could resume oral ingestion. Thereafter anastomotic stenosis occurred between the cervical esophagus and the gastric tube. We performed endoscopic dilatation. After the anastomotic stenosis was relieved, the stent was removed on the 41^st day after the stent placement. After the stent removal, gastric tube dilatation has not recurred. He has been free from gastric tube dilatation and recurrence of esophageal cancer, as of 14 months after the operation.