Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

Abstract

Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation. Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures. Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001). Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.

Endoscopic ultrasonography guided cutting scar of esophageal stricture after endoscopic injection sclerotherapy

“…Ultrasonic endoscopy can clearly show the five layers of the normal oesophagus [22]. When the oesophageal inflammatory stricture scar is detected through ultrasonic endoscopy, the scar tissue is thicker than the normal mucosa, and the location and depth of the scar can be measured exactly [23,24].…”

Caustic esophageal injury in clinical settings

“…9 Corrosive stricture had higher wall thickness compared to anastomotic or peptic stricture (3.51±1.36 mm vs 2.73±1.7 mm and 1.39±0.62 mm, p=0.026) and involved more wall circumference (76.38±26.2% vs 65.54±25.4% and 40.71±14.6%, p=0.021). 16…”

“…6,7,14 No significant difference of wall circumference was found between dilatationrefractory stricture and dilatation-responsive stricture (72.50±27.87% vs 55.23±23.23%, p=0.098). 16 In cases of dilatation failure, surgical therapies may be required, ranging from colonic interposition surgery, 6,13 jejunostomy, 7 or segmental resection and re-anastomoses, gastric tube interposition, or esophagocologastrostomy, 14 may be required. In half of cases, supportive therapy was possible.…”