Stricture in lower stomach tube requires dilating.

[christinehulmes]

After having my Barium Swallow this week i was told that i need a dilatation done in theatre. The lower bit of stomach tube that i have after the oesophagectomy and comes through the diaphram has gone so narrow that the Barium barely trickled through and showed a severe narrowing. The Radiology Consultant came out and told me the bad news that it would need fixing in theatre in case of rupture which could very well happen. Could this part of the stomach tube be removed do you think as i have been told to see surgeon on September 17th to discuss options?

[Hidden]

It is quite commonly done, and if the dilatation works OK it should make a big improvement.

I do not think that ruptures are anything other than rare events, but the idea of it being stretched is a bit scary from a patient's point of view.

I think they can often do it with an endoscope.

I think you should be able to trust your surgeon's advice on this one.

[christinehulmes in reply to Hidden]

You say that it is commonly done. Are you referring to my question where the part of the stomach tube with the stricture can be removed surgically? If so wouldn't this involve a further anastomosis?

[christinehulmes]

Thank you for answering my question. This is a first for me as there is so little information out there for someone in my situation who's got a stricture at the bottom of the stomach tube. I must admit that though i have had a dilatation go wrong on me in the past where the balloon burst on me and that was only a little stricture so you can imagine why i am worried about this one. I shall go by my surgeons advice and if i may post a reply to my own question so that other patients who may face the same situation can read what the options are.

[DaveChuter]

Hi Christine,

I had a stricture at the palaris muscle at the base of the stomach but this may not be quite the same issue as you, mine started to close about 3 years after surgery, reason unknown.

A rupture is a very rare event, I have not come across one within our support group members.

3 dilations with botox worked for a short while each time but I had keyhole surgery to fix completely 18 months ago, this was an overnight stay only and successful.

Go with your consultants advice as they are the experts.

Please do post all experiences and follow up replies to your own queries as it really does help all patients, new and old.

Best wishes and kind regards,

Dave C

[jhampton75 in reply to DaveChuter]

Hi Dave-

I know it's been awhile since your post, but I too now have a stricture and it has also been 3 years since my initial surgery. I had a dilation last week, and will find out my overall options tomorrow, one of which was the keyhole surgery. Do you feel this worked well for you? did you go on to lose more weight? Did it cause you any weight gain?

any info you can share would be greatly appreciated.

Thanks in advance!

Jodi

[DaveChuter in reply to jhampton75]

Hi Jodi,

It was between 3 and 4 years out of initial surgery that I had the same problem, I had 3 dilations which worked well for a while but for me was just short term relief, but I do know of others that the dilations worked as a permanent fix, worth having 2nd one if 1st does last for long.

I then had keyhole surgery, overnight stay only, to open up the stricture which was a permanent fix as now 7 years since the issue so has worked well for me and would recommend it if offered.

Slight weight gain soon after only because I could now eat better without the backing up of food.

Let me know how you get on.

Best wishes and kind regards,

Dave

[malwel]

Hello Christine.

It is five years since my oesophagectomy and during last two years I have had severe reflux and acid nightly. At Christmas I ended up hospitalised with Aspriation pneumonia. As part of the treatment I was given the antibiotic Clarithromycin and it was found by chance that my digestion improved. When I stopped all the symptoms returned.

I had barium swallow and like you it barely trickled through. I was told I needed dilatation to pylorus, however when endoscopy done, (under sedation which I recommend) it was found that the pylorus was OK but there was 'acute angulation to the antrum' ie base of stomach 'creating a possible functional limitation to gastric emptying' This may be what you are experiencing.

No surgery recommended at that stage but I have now been prescribed a daily dose of Clarithromycin 1000mg and I have never felt better in the last five years since op. My energy levels have returned and within reason I can eat anything at anytime without reflux especially when asleep. I feel normal again and can go out to restaurants! (The trouble is I am putting on weight because I can enjoy food again!)

Apparently it is because, as a side effect,the drug increases the muscle contractions that push the food through.These muscles had become ineffective because the vagus nerve had been cut in the op. At my last review with consultant, last week, he is so pleased they will discharge me at next 6 month review if still OK. - the light at the end of a long tunnel.

Because this is rather an unusual and not a widely prescribed use of the drug he recommended 6 monthly blood checks on liver and kidneys,(also B12 levels) which my GP has arranged- he is very helpful and interested in my case ( I see same GP each time for continuity) . Also the consultant suggested contacting the drug manufacturers for advice on long term use. The only down side is a permanent bitter taste but can live with that.

Good Luck

MalWel

[christinehulmes in reply to malwel]

Thank you MalWel for your story. When i see surgeon next week i shall mention the Clarithromycin 1000mg and see what he says but it all depends on the location of the narrowing. At my operation the pylorus was cut as in a myotomy but warned that it could narrow at some point in the future. Maybe it needs doing again i don't know until i talk with the surgeon. He'll know best as he has experience with Achalasia and it's complications. According to my recent Barium there was no muscle contractions at all at the narrowing and that previous scar tissue could be the problem. We'll see.