Surgical reconstruction of caustic esophageal strictures: a retrospective comparative study of esophagogastroplasty and esophagocoloplasty

Abstract

Background: Caustic soda ingestion can result in severe esophageal injuries, leading to chronic strictures that may require surgical reconstruction. Esophagogastroplasty and esophagocoloplasty are the most common surgical options; however, comparative outcome data remain scarce. Methods: We conducted a retrospective analysis of medical records from patients treated for caustic soda ingestion at Hospital João XXIII (HJXXIII), Belo Horizonte, Brazil, between 2014 and 2020. Data were reviewed and finalized in 2024. Among 277 patients, 101 adults had acute esophageal injuries classified by esophagogastroduodenoscopy (EGD). Forty-seven developed esophageal strictures, of whom 34 did not respond to endoscopic dilation and required surgical reconstruction. Of these, 19 underwent esophagogastroplasty and 15 underwent esophagocoloplasty due to significant gastric injuries (atrophy, severe adhesions, or previous gastrostomy). Results: Esophagogastroplasty was performed in 55.9% and esophagocoloplasty in 44.1% of surgical cases. The postoperative mortality rate was 0% in the esophagogastroplasty group and 20% (3/15) in the esophagocoloplasty group. Anastomotic leaks occurred in 21.1% (4/19) and 53.3% (8/15), respectively (p = 0.058, trend toward significance). Most patients resumed oral feeding, and only one required postoperative dilation for anastomotic stricture. Conclusions: Esophagogastroplasty was associated with lower rates of major postoperative complications and no mortality in this cohort of chronic caustic esophageal strictures. Further multicenter studies are needed to confirm these findings and guide surgical decision-making.