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Case Reports
. 2025;11(1):25-0033.
doi: 10.70352/scrj.cr.25-0033. Epub 2025 Jun 18.

Jejunal Interposition with Overlap Esophago-Jejunal Anastomosis for an Esophageal Stricture due to Repeated Endoscopic Dilation for Esophageal Achalasia: A Case Report

Yasuto Suzuki  1 , Shinsuke Takeno  1 , Fumiaki Kawano  1 , Kousei Tashiro  1 , Makoto Ikenoue  1 , Kazunosuke Yamada  1 , Atsushi Nanashima  1
Affiliations
Case Reports

Jejunal Interposition with Overlap Esophago-Jejunal Anastomosis for an Esophageal Stricture due to Repeated Endoscopic Dilation for Esophageal Achalasia: A Case Report

Yasuto Suzuki et al. Surg Case Rep. 2025.

Abstract

Introduction: Achalasia is a primary esophageal motility disorder of unknown origin. The clinical manifestations are caused by the loss of peristalsis of the esophagus and functional obstruction at the esophagogastric junction. There are several treatment strategies for esophageal achalasia, such as medications, endoscopic treatment, and surgery. The successful treatment of a case of jejunal interposition surgery with overlap esophago-jejunal anastomosis for an esophageal stricture due to repeated endoscopic dilation for esophageal achalasia is reported.

Case presentation: The patient was a 67-year-old man who was diagnosed with esophageal achalasia 13 years earlier. Partial esophagectomy of the portion with the stricture and esophago-jejunal anastomosis using the overlap method were performed for the esophageal stricture due to rupture during endoscopic balloon dilatation. The patient's postoperative recovery was unremarkable, and the dysphagia due to esophageal stricture disappeared.

Conclusions: The overlap technique in esophago-jejunal anastomosis after partial esophagectomy was very effective for an esophageal stricture in a patient with achalasia because it made possible the additional resection of endoluminal muscle.

Keywords: esophageal achalasia; esophageal stricture; jejunal interposition; overlap anastomosis.

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Conflict of interest statement

The authors declare no conflicts of interest in association with the present study.

Figures

Fig. 1
Fig. 1. Endoscopic dilatation performed before surgery. Stenosis in the lower esophagus, through which it is difficult to pass the endoscope. The esophagus is dilated from 8 mm to 9 mm, but endoscopic passage is difficult even after dilatation.
Fig. 2
Fig. 2. Esophagogram performed before surgery. Barium stagnation in the esophagus with a smooth narrow appearance (bird’s beak sign) is seen (yellow arrows). Straight type findings with no esophageal meandering. Insufficient dilatation and irregular peristalsis extend into the middle esophagus.
Fig. 3
Fig. 3. The second jejunal artery is dissected, a graft created, and the graft raised dorsally. The esophageal transection and the elevated jejunum are perforated and anastomosed laterally using the overlap technique, and the common hole is sutured with 2 layers of hand stitches. A 60-mm automatic suturing device is used. A gastric and jejunal anastomosis is also performed using the overlap method to prevent stenosis, and pyloroplasty using the HeinekeMikulicz method is added to prevent reflux esophagitis.
Fig. 4
Fig. 4. Esophagography shows no obstruction to passage of the esophago-jejunal anastomosis. Endoscopy shows no stenosis at the esophago-jejunal anastomosis, and endoscopic passage is possible.
See this image and copyright information in PMC

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