Predictors of Early Recurrence of Benign Esophageal Strictures

Said, Adnan; Brust, Donald J.; Gaumnitz, Eric A.; Reichelderfer, Mark

doi:10.1111/j.1572-0241.2003.07490.x

Cited by 92 publications

(10 citation statements)

References 18 publications

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“…In the present study, 25% of patients had history of GERD, but in Said A [13] (2003) study, the incidence was 77 (Table 3).…”

Section: Discussioncontrasting

confidence: 50%

A Study on Dysphagia Due to Benign Oesophageal Strictures

Sharma¹,

Sharma²,

Sethi³

et al. 2017

jemds

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BACKGROUNDGastroesophageal reflux disease, alkali or acid ingestion, achalasia due to unknown aetiology are considered as main causative factors in the genesis of benign oesophageal strictures. The two types of treatment modalities are used including conservative dilatation and surgical approach according to aetiology and site of involvement. Our study attempts to understand the various aetiopathogenesis and epidemiological features of this problem and their clinical presentation; so that early detection maybe planned and various treatment modalities for achalasia cardia, peptic stricture, corrosive stricture and their results are evaluated. The aim of the study is to study various-1. Aetiological factors of stricture oesophagus (benign). 2. Features and clinical presentation of stricture oesophagus, so that early detection maybe planned. 3. Treatment methods of management of benign oesophageal strictures. MATERIALS AND METHODSThis is a descriptive study of dysphagia due to benign oesophageal strictures. Cases presenting in the surgical outdoor with symptoms suggestive of oesophageal stricture and admitted in different surgical and gastroenterology units were included in the study. A detailed history and examination was done in these patients. Management was done by endoscopic or manual dilatation with bougies and/or surgical operation. Surgical management consisted of Heller's cardiomyotomy or oesophagoplasty. RESULTSTotal number of 40 patients of dysphagia due to benign oesophageal strictures were studied out of which 16 (40%) patients were of corrosive strictures, 14 (35%) having achalasia cardia and 10 (25%) of peptic strictures. The male-to-female ratio was 1.35:1. The mean age was 42.62 years. Strictures due to corrosive were more common in younger age groups while 20170912mthe peptic stricture occurred later in life. The incidence of various symptoms were dysphagia 100%, regurgitation 45%, epigastric or substernal pain 35%, weight loss 25% and cough in 12% cases. Patients with GERD or achalasia cardia had more dysphagia to liquid/semi-solids, while patients with corrosive ingestion (alkali/acid) had more dysphagia to solids. The most common site affected was lower third of oesophagus in 55% of cases, followed by middle third (40%) and upper third (5%). In present study, out of 40 patients, 25 patients were treated conservatively in form of dilatation and operative intervention was done in 15 patients. All of the patients of stricture due to GERD were treated by conservative management. Most of the patients with corrosive ingestion/unknown aetiology were treated by conservative management. All of the patients with achalasia cardia were treated by operative management. One patient out of 25 managed with conservative treatment developed complication in the form of oesophageal perforation. Out of 15 patients that were managed by operative treatment, 5 developed pulmonary complications and 5 developed wound infections. Out of 4 patients who had undergone oesophagoplasty, 2 suffered with minor anastomo...

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“…In the present study, 25% of patients had history of GERD, but in Said A [13] (2003) study, the incidence was 77 (Table 3).…”

Section: Discussioncontrasting

confidence: 50%

A Study on Dysphagia Due to Benign Oesophageal Strictures

Sharma¹,

Sharma²,

Sethi³

et al. 2017

jemds

View full text Add to dashboard Cite

show abstract

“…13 However, the risk of recurrence after dilation is considerable for these complex, non-peptic strictures. 1,16,17 …”

Section: Introductionmentioning

confidence: 99%

Esophageal Anastomotic Strictures: Outcomes of Endoscopic Dilation, Risk of Recurrence and Refractory Stenosis, and Effect of Foreign Body Removal

Mendelson

Small

Agarwalla

et al. 2015

Clinical Gastroenterology and Hepatology

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Background & Aims Esophageal anastomotic strictures often require repeat dilation to relieve dysphagia. Little is known about factors that affect their remediation. We investigated long-term success and rates of recurrence or refractoriness following dilation, and factors associated with refractory stenosis. Methods We performed a retrospective study of 74 patients with an anastomotic stricture that had been dilated over a 5-year period (564 dilations; median follow-up period, 8 months). A stricture was refractory if luminal patency could not be maintained after ≥5 dilation sessions over 10 weeks. Results Of the 74 patients, 93% had initial relief of dysphagia. The stricture recurred in 43% of patients, and 69% were considered refractory. Removal of sutures/staples protruding into the lumen did not accelerate time to initial patency (median 37 days; interquartile range [IQR], 20–82 days) or lengthen the dysphagia-free interval (37.4 days; IQR 8–41 weeks), compared to patients who did not undergo removal (initial patency, median 55 days; IQR, 14–109 days; P=.66 and median dysphagia-free interval, 21.7 days; IQR, 9–64 weeks; P=.8). Use of fluoroscopy during dilation (odds ratio=8.92; 95% confidence interval, 1.98–40.14) was positively associated with development of refractory strictures, whereas neoadjuvant chemotherapy (odds ratio=0.28; 95% confidence interval, 0.07–0.97) was inversely associated. Female sex and distal location of strictures increased risk of refractoriness as effect modifiers in multivariate analysis. Conclusions Endoscopic dilation is highly successful in achieving luminal remediation, yet anastomotic strictures are often refractory and frequently recur. Removal of sutures/staples within the lumen does not help achieve patency. Need for fluoroscopic guidance indicates a high likelihood of refractoriness to dilation, whereas prior neoadjuvant chemotherapy indicates a lower risk.

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“…As concluded by the authors, this may indicate ineffective acid suppression or combined acid and alkaline reflux responsible for the recurrence. Nonpeptic strictures were significant predictors of early recurrence [35] .…”

Section: Dilemmas In Medical Treatmentmentioning

confidence: 97%

“…Several factors are known as predictors of early recurrence. Said et al [35] treated 87 outpatients with benign esophageal stricture (77% peptic, 23% nonpeptic) and followed them for 1 year after the initial dilation. The majority of patients were administered PPIs after dilation.…”

Section: Dilemmas In Medical Treatmentmentioning

confidence: 99%

Peptic Esophageal Stricture: Medical Treatment

Pregun

Hritz

Tulassay

et al. 2009

Dig Dis

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Peptic esophageal stricture as a consequence of gastroesophageal reflux disease is the most frequent among benign esophageal strictures. The incidence is low and has been decreasing since the 1990s with a parallel increase in proton pump inhibitor use. Dysphagia is a common symptom: accurate diagnostic procedures (barium esophagogram, upper endoscopy with biopsies) have to be performed to exclude malignant causes first. Medical (acid-suppressive) therapy, endoscopic dilation and surgical intervention are the main therapeutic options. Based on the results of randomized and observational studies evaluating the effect of acid-suppressive therapy on peptic stricture outcome, healing the coexistent esophagitis seems to be essential. Effective acid-suppressive therapy with proton pump inhibitors may reduce the need for repeated dilations and provide symptom relief and better clinical outcome. In refractory strictures, local steroid injection is likely beneficial.

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Predictors of Early Recurrence of Benign Esophageal Strictures

Cited by 92 publications

References 18 publications

A Study on Dysphagia Due to Benign Oesophageal Strictures

A Study on Dysphagia Due to Benign Oesophageal Strictures

Esophageal Anastomotic Strictures: Outcomes of Endoscopic Dilation, Risk of Recurrence and Refractory Stenosis, and Effect of Foreign Body Removal

Peptic Esophageal Stricture: Medical Treatment

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