Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies
- 26 Downloads
Background and Aims
This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).
Materials and Methods
Patients with anastomotic strictures (enrolled during January 1996–December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.
Of the 142 patients, 124 (mean age—44.02; males—74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2–10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.
Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.
KeywordsDeglutition Deglutition disorders Endoscopic dilation Caustic anastomotic strictures Refractory stricture Recurrent stricture
Caustic anastomotic strictures
Non-caustic anastomotic strictures (malignancy of head/neck/esophagus)
Through the scope
Controlled radial expansion
Periodic dilation index
Self-expanding metal stents
The study was not supported by any funding or grants.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the study were in accordance with the ethical standards and formal ethical clearance of the institutional ethics committee of Postgraduate Institute of Medical Education and Research, Chandigarh (20th April 2018 with registration number NK/4377/RES/172) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Ikeya T, Ohwada S, Ogawa T, Tanahashi Y, Takeyoshi I, Koyama T, Morishita Y. Endoscopic balloon dilation for benign esophageal anastomotic stricture: factors influencing its effectiveness. Hepatogastroenterology. 1999;46(26):959–66.Google Scholar
- 5.Kim HC, Shin JH, Song HY, Park SI, Ko GY, Youn HK, Sung KB. Fluoroscopically guided balloon dilation for benign anastomotic stricture after Ivor-Lewis esophagectomy: experience in 62 patients. J Vasc Interv Radiol. 2005;16(12):1699–704. https://doi.org/10.1097/01.RVI.0000185417.89885.2E.CrossRefGoogle Scholar
- 9.Adegboye VO, Brimmo A, Adebo OA. Transhiatal esophagectomy in children with corrosive esophageal stricture. Afr J Med Med Sci. 2000;29(3–4):223–6.Google Scholar
- 10.Park JY, Song HY, Kim JH, Park JH, Na HK, Kim YH, Park SI. Benign anastomotic strictures after esophagectomy: long-term effectiveness of balloon dilation and factors affecting recurrence in 155 patients. AJR Am J Roentgenol. 2012;198(5):1208–13. https://doi.org/10.2214/AJR.11.7608.CrossRefGoogle Scholar
- 12.Mendelson AH, Small AJ, Agarwalla A, Scott FI, Kochman ML. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol. 2015;13(2):263–71. https://doi.org/10.1016/j.cgh.2014.07.010.CrossRefGoogle Scholar
- 23.Hirdes MM, van Hooft JE, Koornstra JJ, Timmer R, Leenders M, Weersma RK, Weusten BL, van Hillegersberg R, van Berge Henegouwen MI, Plukker JT, Wiezer R, Bergman JG, Vleggaar FP, Fockens P, Siersema PD. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures. Clin Gastroenterol Hepatol. 2013;11(7):795–801. https://doi.org/10.1016/j.cgh.2013.01.016.CrossRefGoogle Scholar
- 31.Repici A, Vleggaar FP, Hassan C, van Boeckel PG, Romeo F, Pagano N, Malesci A, Siersema PD. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc. 2010;72(5):927–34. https://doi.org/10.1016/j.gie.2010.07.031.CrossRefGoogle Scholar