Esophageal advancement jejunoplasty (JAE) in the treatment of cervical esophageal strictures

Introduction

Cervical esophageal stenosis is a complex surgical problem when endoscopic treatment fails. The distance between the stenosis and the dental arch (AD) determines the need for a longer flap, with an increased risk of ischemia.

Our group proposed the use of an esophageal advancement jejunoplasty (JAE) in patients with esophageal stenosis less than 17 cm from the AD to “lengthen” the residual esophagus and, in a second stage, complete the reconstruction of digestive transit with a gastroplasty or coloplasty.

Material and method

Descriptive and retrospective analysis of a prospective database of patients who had esophageal stenosis less than 17 cm from the dental arch (DA), who were indicated a JAE between November 2020 and May 2024.

Results

A total of 16 patients with a mean age of 52 years were included. In 13 cases the stenosi was secundary to càustics and 3 to radiotherapy; the mean distance between AD and stenosis was 14 cm. Five cases were reoperated and two esophageal-jejunal fistulas were diagnosed. There was no mortality.

The second stage of reconstruction was completed in 10 patients (5 gastroplasties and 5 coloplasties). Two jejuno-ileal stenosis and one esophageal-jejunal stenosis were diagnosed. Functionally, 5 patients are exclusively nourished orally, 2 through a mixed diet and 3 exclusively enterally.

Conclusion

We believe that JAE can be a technically feasible option, with acceptable morbidity, in patients with upper esophageal stenosis to minimize the risk of ischemia that involves a longer flap.