Does esophageal wall thickness on computed tomography predict response to endoscopic dilatation in patients with corrosive esophageal strictures?

Gupta, Pankaj; Gulati, Ajay; Reddy, Yalaka Rami; Samanta, Jayanta; Kochhar, Rakesh

doi:10.1002/jgh3.12176

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…One research project carried out in Karachi, which involved participation from a total of twenty-seven patients. Endoscopic dilatation with a Savary-Gilliard dilator was performed, and this helped twenty-two out of twenty-seven patients (81.4%) with their dysphagia [13][14].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Khan¹,

Younas²,

Waseem³

et al. 2022

PJMHS

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Objective: The objective of study was to determine the efficacy after endoscopic dilatation in patients of corrosive intake. Study Design: It was descriptive case series Setting: Research was conducted at Medical Unit-III, Services Hospital, Lahore. Duration: Duration of study was 6 months from 1st November 2016 to 30th April 2017. Material and Methods: This study involved 150 patients of age 18-65 years with corrosive intake and dysphagia score ≥ 2. A written informed consent was taken from each patient. Results: Total 150 patients were added in the study. Out of these, 118 patients (78.7%) were females while 32 (21.3%) were males. The age of patient ranged from 18 to 48 years with a mean of 26.72 ±5.61. One hundred thirty two patients (88 %) showed improvement in dysphagia while 18 patients (12 %) did not show any improvement. Efficacy calculated by chi- square test which showed p-value of .000 (statistically significant) Conclusion: 150 patients with dysphagia score ≥ 2 were added in study and dilated with Savary-Gilliard dilator. 132 patients showed improvement in dysphagia with p-value of .ooo (statistically significant).

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Khan¹,

Younas²,

Waseem³

et al. 2022

PJMHS

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“…Nowadays, the use of CT scans of the chest and abdomen is increasing. CT can assist prognosis after ingestion, but it is still inconclusive [25][26][27]. CT also provides extraesophageal information regarding anatomies such as the mediastinum, lung, and pleural cavity, which endoscopies do not (Table 2).…”

Section: Managementmentioning

confidence: 99%

Acute Management in Corrosive Ingestion

Mahawongkajit¹

2022

Dysphagia - New Advances

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Corrosive ingestion is an important health problem and medical emergency worldwide. It occurs by accident or by intention. Acids cause coagulation necrosis, and alkalis cause liquefaction necrosis. In the acute period, stabilization of the patient is most important. Airway assessment and prompt management are a priority for severe cases. Caustic substance reflux into the esophagus resulting in further damage should be prevented. The initial evaluation should be performed by endoscopy and graded according to the Zargar classification. Computed tomography (CT) should be used to assess injury to the esophagus because CT is non-invasive. For Zargar 3b injuries, views from both endoscopy and CT scans should be considered. Post-corrosive esophageal stricture is a complication that responds poorly to treatment. Research and development for stricture prevention are ongoing, especially for Zargar 2b and 3a cases.

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“…They found that patients with maximal wall thickness ≥ 9 mm required more dilations. However, a recent study of 64 patients with corrosive strictures showed that median CT esophageal wall thickness was 7 mm (range 3 -22 mm) and that it did not predict technical or clinical success, refractory or recurrent strictures and adverse events of endoscopic dilation [5]. CT can evaluate overall wall thickness, but it cannot delineate the wall layers and hence their degree of involvement.…”

Section: Eus Mini-probe Layers Of Esophageal Wall Involvementmentioning

confidence: 99%

“…Techniques that have been studied to predict response to endoscopic dilations include contrast-enhanced computed tomography (CECT) scans and endoscopic ultrasound (EUS). Esophageal wall thickness (EWT) on CECT has been found to correlate with response to dilation in one study [4] but not in another [5]. EUS, using radial probe, placed at the proximal margin of the stricture, has been used to predict response to dilation based on the depth of tissue injury, i. e. the number of layers of esophageal wall involved [6].…”

Section: Introductionmentioning

confidence: 99%

Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

et al. 2020

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Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation. Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures. Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001). Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.

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Does esophageal wall thickness on computed tomography predict response to endoscopic dilatation in patients with corrosive esophageal strictures?

Cited by 4 publications

References 9 publications

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Acute Management in Corrosive Ingestion

Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

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