Factors associated with esophagojejunostomy stricture and its clinical impact after gastrectomy: a 10-year single-center study.

PURPOSE: Esophagojejunostomy (EJ) stricture is a clinically significant complication following proximal and total gastrectomy, yet the underlying factors contributing to its development and its long-term implications remain poorly defined. This study evaluated the incidence, risk factors, and clinical impact of EJ stricture in patients undergoing gastrectomy for gastric adenocarcinoma.

METHODS

A retrospective cohort study was conducted that included all consecutive patients who underwent proximal or total gastrectomy with EJ reconstruction for gastric adenocarcinoma at a tertiary referral center (2014-2024). The primary outcome was stricture incidence, and the independent factors associated with stricture were identified. Secondary outcomes included management patterns, readmissions, complications, and survival. Logistic regression was used to identify factors independently associated with stricture; survival was evaluated using Kaplan-Meier analysis.

RESULTS

Among 139 patients, 15 (10.8%) developed EJ stricture; of these, three cases (20%) were later attributed to malignant recurrence. Baseline demographics, comorbidity profiles, operative approach, and tumor characteristics were similar between groups. Stricture patients were significantly more likely to have undergone circular anastomosis, either manual or stapled, compared with linear stapled EJ. Multivariable analysis identified circular EJ as the only factor independently associated with stricture (manual: OR 5.94, p = 0.013; stapled: OR 5.44, p = 0.018). Stricture patients had higher readmission rates at 30 days (53.3% vs. 17.7%, p = 0.004) and at 1 year (86.7% vs. 46.8%, p = 0.004). Median overall survival was significantly reduced among patients with stricture (18.2 vs. 29.3 months, p = 0.046). Malignant recurrence was identified in 20% of stricture cases.

CONCLUSIONS

EJ stricture occurred in approximately 11% of gastrectomy patients and was strongly associated with circular anastomotic techniques. Stricture formation led to significantly increased readmissions and worse survival, partly due to malignant recurrence presenting as stricture. Linear stapled EJ may reduce the risk of stricture and should be considered when feasible.