Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect

Abstract

BackgroundThe optimal target of endoscopic dilation of postsurgical esophageal strictures is unknown. Our aim was to compare the dilation-free period of patients who underwent dilation up to 16 mm with patients who were dilated up to 17 or 18 mm.MethodsWe retrospectively analyzed adult patients who received bougie/balloon dilation for a benign anastomotic stricture after esophagectomy. An anastomotic stricture was defined as dysphagia in combination with a luminal diameter of ≤13 mm at endoscopy. We analyzed the dilation-free period using Kaplan–Meier and multivariable Cox regression analysis.ResultsEighty-eight patients were dilated up to a maximum diameter of 16 mm and 91 patients to a diameter >16 mm. The stricture recurrence rate was 79.5 % in the 16 mm group and 68.1 % in the >16 mm group (p = 0.083). The overall dilation-free period had a median of 41.5 (range 8–3233) days and 92 (range 17–1745) days, respectively (p < 0.001). For patients who developed a stricture recurrence, the median dilation-free period was 28 (range 8–487) days and 63 (range 17–1013) days, respectively (p = 0.001). Cox regression analysis showed a reduced risk of stricture recurrence for patients who were dilated up to >16 mm: crude hazard ratio (HR) 0.57 (95 % confidence interval (CI) 0.41–0.81) and adjusted HR 0.48 (95 % CI 0.33–0.70).ConclusionsEndoscopic dilation over 16 mm resulted in a significant prolongation of the dilation-free period in comparison with dilation up to 16 mm in patients with benign anastomotic strictures after esophagectomy.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-5187-0) contains supplementary material, which is available to authorized users.

Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation

“…Unlike a study of esophageal stricture by Gundogdu et al, 22 in which all strictures were caused by corrosive injury, the authors found that strictures of less than 5 cm had a higher EBD success rate. 20 A similar conclusion was found in the study by Cakmak et al, where the treatment effectiveness of EBD was higher, and complication rates were lower in esophageal strictures <5 cm compared with longer ones among patients with corrosive injury or EA related anastomotic stricture. 19 Our study supports this observation, the complication rate is significantly higher in corrosive injury patients with stricture length >5 cm in our series.…”

“…19 van Halsema et al observed that endoscopic dilation over 16 mm significant extended the dilation-free period in comparison with dilation up to 16 mm in patients with benign anastomotic strictures after esophagectomy. 20 The EBD sessions in our patients support this observation. Alkaline corrosive esophagitis was the second most common cause of esophageal stricture in our series; most cases (76.9%) had highest grades of corrosive esophagitis on endoscopy.…”

Esophageal Stenting in Clinical Practice: an Overview

“…As opposed to EBD, a temporary stent acts as a dilator that is kept in place for a substantially longer time of several weeks. Notorious etiologies of BES, associated with a high risk of becoming refractory to repeated EBD are caustic, radiation-induced, and esophagogastric anastomotic strictures [ 36 – 39 ]. A rising incidence of post-endoscopic strictures is expected as a consequence of new endoscopic interventional treatment modalities in daily clinical practice.…”

How to Approach a Patient With Refractory or Recurrent Benign Esophageal Stricture

“…For anastomotic strictures it has been shown that endoscopic dilation of >16 mm results in a prolongation of the dilationfree period compared with 16 mm. 6 It seems likely that this finding also applies to other types of esophageal strictures.…”