The role of endoscopic dilation and stents in refractory benign esophageal strictures: a retrospective analysis

Abstract

Background The outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking. Our objective was to explore the role of endoscopic dilation and stents placement in the management of RBES. Methods RBES patients treated with dilation and stents in our hospital between January 2009 and December 2017 were included in this study. The primary outcomes were to assess clinical effectiveness and adverse events. The secondary outcome was to identify factors that predicted the dysphagia-free period. Results Among 75 RBES patients (54 male; median age 59 years), 39 (52%), 20 (26.7%), 3 (4%), 10 (13.3%), and 3 (4%), were postsurgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median number of endoscopic therapy was 5 times (range 3, 21). Endoscopic therapy was successful in 46 patients (61.3%). Patients treated with dilation showed a higher success rate (70.9%, 39/55) than that treated with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The patients treated with dilation demonstrated a dysphagia-free period of 3.7 months (95% CI, 2.7–5), while patients treated with stents displayed a dysphagia-free period of 2.3 months (95% CI, 1.5–3). The dysphagia-free period had a linear growth trend over time, with an increase of 12 days per endoscopic therapy. Conclusion The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic therapy tended to be effective in patients with RBES by increasing the dysphagia-free period. However, compared to dilation therapy, stent therapy was not effective in increasing the dysphasia-free period and reducing the times and frequency of dilation. In addition, univariate and multivariate analyses also indicated that etiology may predict the endoscopic therapy outcome. Trial registration This study was retrospectively registered and approved by the Ethics Committee of West China Hospital of Sichuan University (IRB number: ChiCTR1800016321 ).

Triple intramural dexamethasone injections increase the efficiency of endoscopic bougienage of esophageal re-stenosis and anastomosis

“…Бужирование и баллонная дилатация являются классическими методами лечения. По данным литературы, примерно 30% доброкачественных стриктур пищевода и пищеводных анастомозов склонны к рестенозу [10]. Хорошим результатом дилатации считается просвет 14 мм, при котором баллон диаметром 15 мм после выполненного сеанса свободно извлекается из зоны сужения в заполненном состоянии.…”

“…Альтернативный путь дилатации стриктур с тенденцией к рестенозу -временная установка полностью покрытых саморасправляющихся стентов на очень короткий срок либо биодеградирующих эндопротезов. Но эта методика при доброкачественных стриктурах сопровождается значительным числом осложнений, а долгосрочные результаты остаются неясными и не настолько обнадеживающими, как представлялось вначале [10,20].…”

Kostik madde içimi sonrası gastrointestinal darlık gelişen hastalarda endoskopi tecrübemiz

“…Bu hastalarda stentlerin uzun süreli rahatlama için yetersiz olduğu belirtilmiştir (17). Ayrıca yapılan bir diğer çalışmada dilatasyon tedavisi ile karşılaştırıldığında stent tedavisinin, disfajisiz dönemi arttırmada ve dilatasyon sürelerini ve sıklığını azaltmada etkili olmadığı gösterilmiştir (18).…”

A few comments about benign esophageal strictures

“…In our previous study, the stents were placed 6 times in 2 patients with refractory BES patients in only 4 ED sessions. 4 The use of stents can affect the analysis of efficacy of endoscopic dilation. Second, the dysphagiafree period is considered a better proxy for survival quality, rather than the time from first to last endoscopic dilation.…”