Flemming S, Lock JF, Hankir M, Reimer S, Petritsch B, Germer CT, Seyfried F. Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up: A case report. World J Clin Cases 2021; 9(16): 3971-3978 [PMID: 34141755 DOI: 10.12998/wjcc.v9.i16.3971]
Corresponding Author of This Article
Sven Flemming, MD, Academic Research, Senior Research Fellow, Surgeon, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberdü9rrbacher STr. 6, Würzburg 97080, Germany. flemming_s@ukw.de
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 6, 2021; 9(16): 3971-3978 Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3971
Successful management of therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up: A case report
Sven Flemming, Johan F Lock, Mohammed Hankir, Stanislaus Reimer, Bernhard Petritsch, Christoph-Thomas Germer, Florian Seyfried
Sven Flemming, Johan F Lock, Mohammed Hankir, Christoph-Thomas Germer, Florian Seyfried, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Würzburg 97080, Germany
Stanislaus Reimer, Department of Internal Medicine II, Section of Gastroenterology, University Hospital of Wuerzburg, Würzburg 97080, Germany
Bernhard Petritsch, Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg 97080, Germany
Author contributions: Flemming S, Lock JF, Hankir M (native speaker) and Seyfried F wrote the manuscript; Seyfried F and Reimer S lead overall treatment; Seyfried F and Lock JF performed revisional surgery; Reimer S lead endoscopic treatment; Flemming S and Petritsch B prepared the figures; Germer CT supported infrastructure and organizational issues; all authors read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sven Flemming, MD, Academic Research, Senior Research Fellow, Surgeon, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberdü9rrbacher STr. 6, Würzburg 97080, Germany. flemming_s@ukw.de
Received: December 21, 2020 Peer-review started: December 21, 2020 First decision: February 11, 2021 Revised: February 26, 2021 Accepted: March 24, 2021 Article in press: March 24, 2021 Published online: June 6, 2021 Processing time: 143 Days and 12.9 Hours
Abstract
BACKGROUND
Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks, fistulas or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperations may be necessary. Here, we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.
CASE SUMMARY
A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital. Since endoscopic approaches including balloon dilatation and stenting failed, retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.
CONCLUSION
Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
Core Tip: Esophageal surgery with gastric pull-up reconstruction remains the only curative therapy for malignant tumors of the esophagus. Despite significant progress in minimally invasive techniques and improvements in perioperative care/complication management, it is still associated with high rates of morbidity and mortality such as anastomotic leak, fistula and stenosis. One of the most frequent long-term functional complications of esophageal surgery with gastric pull-up is delayed gastric emptying which can be usually treated successfully by endoscopic approaches. However, there are cases with a therapy-refractory complaints where salvage operations are required. Here, we present such a case where an operation with secondary colonic pull-up after oncological esophagectomy with gastric tube reconstruction was performed due to pseudoachalsia caused by an anastomotic stenosis that was refractory to endoscopic interventions.
