Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study

Vermeulen, Bram D.; Zwart, Merle de; Sijben, Jasmijn; Soons, Elsa; Weerd, Lucie van der; Arese, D.; Hoff, Daan W. Von den; Craviotto, Vincenzo; Tan, Adriaan C.; Groenen, Marcel; Bogte, Auke; Repici, Alessandro; Spaander, Manon C.W.; Siersema, Peter D.

doi:10.1016/j.gie.2019.12.040

Cited by 26 publications

(16 citation statements)

References 34 publications

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“…Review of studies which included greater than 100 patients with benign upper GI strictures, either anastomotic, achalasia, post-ESD, eosinophilic, gastric outlet obstruction or mixed aetiology, reveals a risk of haemorrhage well below 1%. [131][132][133][134][135][136][137][138][139][140] A systematic review and meta-analysis of studies of endoscopic dilatation of gastroduodenal Crohn's disease strictures revealed a 2.1% per procedure risk of haemorrhage. 141 In a prospective study of dilatation in 55 patients with oesophageal carcinoma no clinically relevant haemorrhage was observed.…”

Section: Endoscopic Dilatationmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Veitch

Radaelli

Alikhan

et al. 2021

Gut

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This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

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Section: Endoscopic Dilatationmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Veitch

Radaelli

Alikhan

et al. 2021

Gut

View full text Add to dashboard Cite

show abstract

“…Review of studies which included greater than 100 patients with benign upper GI strictures, either anastomotic, achalasia, post-ESD, eosinophilic, gastric outlet obstruction or mixed etiology, reveals a risk of haemorrhage well below 1 % 131 132 133 134 135 136 137 138 139 140 . A systematic review and meta-analysis of studies of endoscopic dilatation of gastroduodenal Crohn’s disease strictures revealed a 2.1 % per procedure risk of haemorrhage 141 .…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

et al. 2021

View full text Add to dashboard Cite

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

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“…We read with interest the letter by Doctor et al 1 and would like to respond to their concerns. Their first concern is related to not following the rule of 3 because it may increase the risk of esophageal perforation.…”

Section: Responsementioning

confidence: 99%

Outcomes of dilation of benign esophageal strictures: a few comments

Doctor

Desai

Abraham

2021

Gastrointestinal Endoscopy

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We commend Vermeulen et al 1 for their article on endoscopic dilation of benign esophageal strictures. Although we generally agree with their conclusions, some points need comment.Our major concern is breaching the "rule of 3." Richter 2 and Johnson 3 recommend that the rule of 3 should not be abandoned. The contrary view by Grooteman et al, 4 that breaching the rule of 3 was not associated with an increase in perforation rates, needs to be interpreted with caution. Esophageal perforations may be rare but can have disastrous adverse events. We believe that this rule should not be broken, especially in strictures with transmural fibrosis such as radiation and complex strictures.The authors classified radiation strictures as benign strictures. It is worth emphasizing that many of these strictures often have residual or recurrent disease, and this may influence the outcome of endoscopic dilation. 5 Measurement of stricture by the diameter of the first dilator has a fallacy. The diameter of the first dilator is decided by visual impression, and 1 size larger than the estimated stricture size is recommended to start with. 6 The authors found no difference in the outcomes of dilation for strictures <1 cm or >1 cm, which is in contradiction to earlier studies. 7 A quarter of the patients in this study who underwent endoscopic stent placement experienced clinical success, which is lower than in other reported studies. 8 One reason could be that, unlike in previous studies, the authors treated a heterogenous group of patients with various causes of stricture (higher proportion of patients with anastomotic stricture) and performed a wide range (1 to 25) of dilation sessions before resorting to stent placement.Finally, a small statistical point: instead of providing the mean number of dilations as decimals, providing median numbers would have been more appropriate.

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Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study

Cited by 26 publications

References 34 publications

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Outcomes of dilation of benign esophageal strictures: a few comments

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