Endoscopic balloon dilatation for benign fibrotic strictures after curative nonsurgical treatment for esophageal cancer

Yoda, Yusuke; Yano, Tomonori; Kaneko, Kazuhiro; Tsuruta, S.; Oono, Yasuhiro; Kojima, Takashi; Minashi, Keiko; Ikematsu, Hiroaki; Ohtsu, Atsushi

doi:10.1007/s00464-012-2273-9

Cited by 52 publications

(55 citation statements)

References 23 publications

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“…A multivariate analysis has shown that circumferential tumor extension of more than three-quarters of the lumen is a risk factor for post-operative stricture after esophageal ESD (5). Patients suffering from dysphagia undergo repeated endoscopic dilation, such as endoscopic balloon dilation (EBD) or dilation with a bougie, for a long period if they have severe esophageal stricture due to extended ESD (3,6,7). Multiple sessions of endoscopic dilation cause substantial suffering for patients, discomfort in the dilation session and increased risk of bleeding or esophageal perforation, as well as potentially being more expensive (7).…”

Section: Introductionmentioning

confidence: 99%

“…Patients suffering from dysphagia undergo repeated endoscopic dilation, such as endoscopic balloon dilation (EBD) or dilation with a bougie, for a long period if they have severe esophageal stricture due to extended ESD (3,6,7). Multiple sessions of endoscopic dilation cause substantial suffering for patients, discomfort in the dilation session and increased risk of bleeding or esophageal perforation, as well as potentially being more expensive (7). To avoid or minimize the disadvantages, the prevention of esophageal stricture after extended ESD is needed.…”

Section: Introductionmentioning

confidence: 99%

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A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

Tanaka¹,

Eba²,

Mizusawa³

et al. 2015

Jpn. J. Clin. Oncol.

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A randomized Phase III trial commenced in Japan in September 2014. Endoscopic local steroid injection has been commonly used and considered acceptable as the current standard treatment for the prevention of esophageal stricture after endoscopic submucosal dissection for superficial esophageal cancer. The purpose of this study is to confirm the superiority of prophylactic oral steroid administration following endoscopic submucosal dissection in terms of stricture-free survival over endoscopic local steroid injection for patients with superficial esophageal cancer. A total of 360 patients will be accrued from 35 Japanese institutions within 2.5 years. The primary endpoint is stricture-free survival, and the secondary endpoints are the number of endoscopic balloon dilations for 12 weeks after endoscopic submucosal dissection, adverse events, serious adverse events and the proportion of patients with dysphagia score ≤1 at 12 weeks after endoscopic submucosal dissection. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000015064

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

Tanaka¹,

Eba²,

Mizusawa³

et al. 2015

Jpn. J. Clin. Oncol.

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“…This study involved the artificial creation of long esophageal strictures (> 20 mm) in a porcine model. A small clinical study found that strictures of this length are at high risk of becoming refractory [14]. Therefore, this animal model is similar to refractory esophageal strictures observed in human patients.…”

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confidence: 50%

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2016

Endosc Int Open

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“…Most authors defined clinical success as resolution of dysphagia (or tolerance of soft diet) measured by different scores [2, 12, 14-16, 18, 19], often requiring a variable dilation-free period [11,13,18,20,21] and considering percutaneous endoscopic gastrostomy (PEG) status [20,22,23]. Francis et al [22] also reported patient satisfaction with the dilation program.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the variable concept of efficacy, it is known that the majority of patients with benign strictures will be effectively treated with up to five dilations [15], but about one-third of patients will develop recurrent dysphagia af- ter dilation within the first year, and 10% of patients will need ongoing dilations to become dilation free [14,16,18]. On the other hand, only 1 out of 3 refractory benign strictures will achieve clinical resolution defined as no need for endoscopic dilation, surgery, or PEG for a 6-month period [20].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

Martins

Pires

Pimentel‐Nunes

et al. 2018

GE Port J Gastroenterol

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Background/Aims: Dysphagia due to benign pharyngoesophageal strictures (PES) often requires repeated dilations; however, a uniform definition for the therapeutic efficacy of this technique has not been yet established. We aimed to assess the overall efficacy of endoscopic dilation of pharyngoesophageal anastomotic or post-radiotherapy (post-RT) strictures. Methods: The data of 48 patients with post-RT (n = 29) or anastomotic PES (n = 19) submitted to endoscopic dilation during a 3-year period were retrospectively assessed. The Kochman criteria were used to determine refractoriness and recurrence. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as (a) dysphagia improvement, (b) dysphagia resolution, (c) need for further dilations, or (d) percutaneous endoscopic gastrostomy (PEG) during the previous 6 months. Need for additional therapy was considered an inefficacy criterion. Results: The median number of dilations per patient was 4 (total of 296 dilations) with a median follow-up of 29 months. The mean predilation dysphagia Mellow-Pinkas score was 3 and the initial stenosis diameter was 7 mm. Fifteen and 29% of patients presented with the Kochman criteria for refractory and recurrent strictures, respectively. Moreover, 96 and 60% showed dysphagia improvement and resolution, respectively. Seventy-five-percent did not require dilations during 6 months, and 89% did not require PEG. From the patients' perspective, overall efficacy was achieved in 58% of cases. Nine additional therapies were required. Number of dilations (OR 0.7), stricture diameter (OR 2.2), and nonrecurrence criteria (OR 14.2) appeared as significant predictors of overall efficacy, whereas refractory stenosis criteria did not. Conclusions: Endoscopic dilation seems to be effective for patients with dysphagia after RT or surgery, especially when assessed as patient perception of improvement. Narrow strictures, recurrent ones, and strictures requiring a higher number of dilations may predict worse outcomes. Key Message: Health professionals should establish well-defined efficacy criteria for dilations and base their decision beyond exclusively objective measurements. Dilatação Endoscópica de Estenoses FaringoEsofágicas: Mais Dimensões do que Diâmetros Palavras Chave Estenoses esofágicas benignas · Endoscopia · Dilatação · Satisfação pessoal · Resultado do tratamentoResumo Introdução e objetivo: A disfagia devido a estenoses faringo-esofágicas benignas requer frequentemente dilatações repetidas, não existindo, contudo, uma definição estabelecida para a eficácia desta terapêutica. Pretendemos avaliar a eficácia-global de dilatações endoscópicas de estenoses rádicas e anastomóticas faringo-esofágicas. Métodos: 48 doentes com estenoses pós-radioterapia (n = 29) e estenoses anastomóticas (n = 19) submetidos a dilatação endoscópica durante um período de 3 anos foram avaliados retrospetivamente. Os critérios de Kochman foram utilizados para determinar refratariedade e recorrência. Os doentes fora...

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Endoscopic balloon dilatation for benign fibrotic strictures after curative nonsurgical treatment for esophageal cancer

Abstract: EBD for stricture after nonsurgical treatment of esophageal cancer was safe and effective. However, patients with benign strictures after nonsurgical treatment required significantly longer time to recover from dysphasia compared to those after surgery.

Cited by 52 publications

References 23 publications

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

A Phase III study of oral steroid administration versus local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217, Steroid EESD P3)

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Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

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