Natural history and management of refractory benign esophageal strictures

Repici, Alessandro; Small, Aaron J.; Mendelson, Aaron H.; Jovani, Manol; Correale, Loredana; Hassan, Cesare; Ridola, Lorenzo; Anderloni, Andrea; Ferrara, E.C.; Kochman, Michael L.

doi:10.1016/j.gie.2016.01.053

Cited by 73 publications

(59 citation statements)

References 28 publications

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“…Endoscopic dilation still is the standard management of PES [20,27]; however, there are no established definitions of therapeutic efficacy or predictive factors for nonresponsive PES.…”

Section: Discussionmentioning

confidence: 99%

“…We designed our definition of overall efficacy as a trilogy where dysphagia improvement assessed as a "patient-reported outcome" needs to be associated with a 6-month period of absence of further dilations and PEG feeding. These criteria made our efficacy definition more demanding and therefore hard to compare with previously described endoscopic dilation efficacy rates [2,12,15,16,18,20,23]. A recent meta-analysis [7] reported an estimated overall clinical success rate per patient (with a post-chemotherapy and RT or RT alone stricture) of 72.9% (95% CI 65.7-80.1%), with data suffering from significant heterogeneity as success was defined by resolution or improvement of different dysphagia scales.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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%

See 3 more Smart Citations

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 dilation still is the standard management of PES [20,27]; however, there are no established definitions of therapeutic efficacy or predictive factors for nonresponsive PES.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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%

See 2 more Smart Citations

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

Martins

Pires

Pimentel‐Nunes

et al. 2018

GE Port J Gastroenterol

View full text Add to dashboard Cite

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“…The studies available in the literature are mostly retrospective, reporting few cases and/or quite heterogeneous data (also regarding esophageal perforations and strictures) [2,3,[13][14][15][16][17][18][19][20][21][22][23]. Moreover, a number of studies reported the outcome of SEMS placement without evaluating possible differences related to stent type [24,25].…”

Section: Discussionmentioning

confidence: 99%

Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

et al. 2018

Self Cite

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Background/Aims: The study aimed to evaluate the effectiveness and safety of self-expanding metal stents (SEMS) in the management of post-surgical esophageal leaks. Methods: Retrospective data of consecutive patients with a post-surgical esophageal leak treated by means of a metal stent between January 2008 and December 2014 at the Humanitas Research Hospital (Milan, Italy) were extracted from a prospectively maintained register of SEMS used for benign indications, such as post-surgical benign esophageal strictures and/or leaks. The primary outcome of the study was to assess the rate of successful leak closure and to identify the variables associated with its achievement. As a secondary outcome, we evaluated the overall safety of SEMS placement and the efficacy and safety for different types of SEMS in this specific setting of patients. Leak resolution was documented with endoscopic and/or imaging studies. In the case of leak persistence, further attempts of esophageal stenting were carried out at the discretion of both endoscopists and surgeons. Results: A total of 49 patients were included in the study (men 41 of 49, 83.7%, mean age 62.4 ± 11.9). One patient was excluded from analysis, because of death 1 day after stent insertion due to worsening of pre-existing mediastinitis. A total number of 82 stents were placed (mean number of stents per patient: 1.7) in 49 patients: 35 patients (71.4%) received a partially covered SEMS (PCSEMS) as the first stent positioned, while the remaining 14 (28.6%) received a fully covered SEMS (FCSEMS); but 1 patient (2%) died following stent insertion; therefore, data regarding therapeutic success were available for 48 patients. Stents were left in place for a mean period of 21.9 ± 15.2 days. Leak closure after the first stent placement was achieved in 22 of 48 (45.8%) patients. Of the 26 patients with failure of index stent placement, 18 patients underwent further stenting attempts (69.2%), and secondary closure of leak was achieved in 7 (38.9%) of these 18 patients. Thus, the overall success rate was 60.5% (29 of 48). On the basis of stent type, the success rate was 57.1% (8 of 14) for FCSEMS and 64.7% (22 of 34) for PCSEMS. Logistic regression analysis did not find any significant association between successful leak closure and analyzed variables. Overall mortality was 13.0%. Complication rate was 38.8% (19 of 49 patients). Conclusion: The use of SEMS is an effective and safe option for post-surgical esophageal leaks, with no evidence of any significant influence of stent type on outcome.

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Esophageal Strictures

Sethi¹,

Richter²

2021

The Esophagus

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Natural history and management of refractory benign esophageal strictures

Cited by 73 publications

References 28 publications

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

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

Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

Esophageal Strictures

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