Dilation of refractory benign esophageal strictures

Siersema, Peter D.; Wijkerslooth, Laetitia R H de

doi:10.1016/j.gie.2009.07.004

Cited by 137 publications

(114 citation statements)

References 69 publications

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“…And surgery can provide definitive treatment but has been associated with considerable mortality and morbidity, including the development of new anastomotic strictures [9,15,19,24,25]. So, unsuccessful management of benign esophageal stricture by serial endoscopic dilatation or surgery and the management of these refractory strictures have been considered challenging [9,26,27]. As a result, the use of temporary stent for the treatment of benign esophageal disease has advanced immensely over the past decade.…”

Section: Discussionmentioning

confidence: 99%

“…Full text retrieval (40) Total full text retrieval (26) Total studies retrieval (30) Total studies for data collection (14) Duplicates (14) Additionally studies detected based on references (4) No detailed data on use of stents for benign esophageal diseases (16) Fig. 1 Flowchart of search history on stents for benign esophageal diseases over SEMS is that endoscopic removal is not needed.…”

Section: Discussionmentioning

confidence: 99%

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Literature Analysis of the Treatment of Benign Esophageal Disease with Stent

et al. 2015

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To analyze the efficacy and safety of benign esophageal disease used biodegradable (BD) stent or metal stent. The English literatures of benign esophageal disease that were treated by biodegradable or metal stents implantation were retrieved and summarized. In all 323 benign esophageal disease, the most common etiologies were benign refractory stricture, surgical anastomotic stricture and esophageal fistula/leak/perforation, but the main characteristics between the two groups were not significantly different. One hundred fifty-four cases were completely healed by using BD stents or self-expandable metal stents (SEMS) (47.7 %). Clinical success was achieved in 47.7 % of all patients and there was no significant difference between BD stents (51 %) and SEMS (46.2 %) (P=0.472), while stent migration occurred more frequently with SEMS (33.9 %) than with BD stent (19.6 %) (P≤ 0.05), and tissue in-or overgrowth occurred more frequently with SEMS (22.2 %) than with BD stents (8.8 %) (P≤0.05). Furthermore, the time about degradation of BD stents in esophageal was longer than removal of SEMS from the esophagus (P≤0.05). Placement of BD stents or SEMS provides effective and safe relief for benign esophageal disease. Clinical success and mortality were not significantly different. BD stents offers an advantage of fewer complications. Although stent placement is a viable strategy in patients with benign esophageal disease, the ideal treatment strategy and further randomized trials with large number of patients are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Literature Analysis of the Treatment of Benign Esophageal Disease with Stent

et al. 2015

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“…The esophageal stricture is quite refractory [1][2][3][4] . Because our present results showed that the failure load of the scar tissue was significantly decreased, a risk of perforation by the dilatation therapy should be considered.…”

Section: Macroscopic Appearance and Histological Findingsmentioning

confidence: 99%

“…Benign esophageal stricture often follows severe inflammation of the esophageal wall, which is caused by chronic reflux of gastric acid, radiation injury, or accidental ingestion of alkali 1,2) . Furthermore, according to recent advances in endoscopic therapy for early stage esophageal carcinoma or high-grade dysplasia, the incidence of esophageal stricture has been increasing as a complication after mucosal resection for widespread lesions 3,4) .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, according to recent advances in endoscopic therapy for early stage esophageal carcinoma or high-grade dysplasia, the incidence of esophageal stricture has been increasing as a complication after mucosal resection for widespread lesions 3,4) . Patients often develop refractory esophageal stricture and need to undergo periodic balloon dilatation [2][3][4] . The fibrotic changes and scar formation that occurs because of the healing process have been the most commonly recognized causes of esophageal stricture.…”

Section: Introductionmentioning

confidence: 99%

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The mechanism of esophageal stricture after endoscopic resection: Histological and biomechanical evaluation in a canine model

Honda

Kobayashi

Nakayama

et al. 2017

Ann. Cancer Res. Therap.

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Background and study aims: Benign esophageal stricture has major deleterious effects on a patient's quality of life and is often refractory. This study aims were to prepare the animal model and to investigate the mechanism of esophageal stricture in the view point of histological and biomechanical evaluation. Material and method: Nine beagle dogs were enrolled in this study. Under general anesthesia, circumferential endoscopic submucosal dissection was carried out 5 cm length in thoracic esophagus for preparing stricture models. The process of stricture formation was evaluated by the endoscopic observation and histological findings. Immunohistochemical staining was performed for collagen I or collagen III. In the biomechanical evaluation, rectangular-shaped specimens were obtained from the esophageal samples. The failure load and linear stiffness were measured using a tensile tester and compared healed tissue with normal. Results: The dogs developed severe stricture. The macroscopic appearance showed a deep ulcer formation and severe mucosal constriction. No esophageal glands or muscularis mucosae were evident, and instead, they were replaced with condensed granulation tissue that were composed type I and III collagen fibers. The inner circular muscular layer of the muscularis propria showed partial atrophy and fibrosis in the center of the lesion. The failure load and linear stiffness were significantly decreased in the healed tissue. Conclusion:The cause of benign esophageal stricture might have been the biomechanical deterioration that was caused the change of the collagen components in the submucosal layers or atrophic changes of inner circular muscles.

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