Endoscopic radial incision method for two strictures of the esophagus after endoscopic submucosal dissection: a case report

Abstract

Background: The development of severe esophageal stricture after endoscopic submucosal dissection (ESD) for early esophageal carcinoma is not uncommon. Dilation by Savary-Gilliard dilators or balloon dilators is the first-line treatment for such complex refractory benign stricture, but it has a high risk of treatment failure. So far, endoscopic radial incision (ERI) as a new technology for the treatment of post-ESD esophageal stricture has been rarely reported. We report a case, which we designed to assess the efficacy and safety of ERI technology for two severe strictures of the esophagus after ESD. Case presentation: A 67-year-old man had suffered from two complex refractory benign strictures of the esophagus after ESD for early esophageal carcinoma. The patient was refractory to multiple endoscopic balloon dilation (EBD) therapy previously. Thus, the patient underwent ERI successfully and without postoperative complications such as fever, poststernal pain, bleeding, and perforation. During 3 months of follow-up after ERI, the patient had no recurrence of dysphagia. Conclusions: Refractory strictures of the esophagus after ESD are common. ERI is a safe and efficient strategy for treating such multiple refractory esophageal strictures.

Benefits of precise endoscopic incision on post-dilation mucosal scars to treat refractory esophageal stricture after endoscopic submucosal dissection

“…Also, because it is difficult to inject medium beneath scar tissue, dissection can be arduous and risky. Nevertheless, there have been a few reports about using ERI or RIC to treat refractory esophageal stenosis after ESD, all with favorable results, although with relatively high perforation rate, demonstrating the feasibility of this technique 5 7 9 .…”

“…Due to the technical challenges and risks of ERI, it is usually reserved as a second-line treatment for refractory esophageal stenosis after ESD. Currently, there are only a few reports evaluating the role of ERI in treating esophageal stenosis 5 6 7 .…”

Comparison of endoscopic radial incision and Savary-Gilliard’s bougie dilation in efficacy on refractory esophagogastric anastomosis strictures

“…However, only one session of ERI is enough to reach grade 0 swallowing symptoms. The patients undergoing ERI also had a lower incidence of complications such as bleeding, perforation and late recurrence (24,25). During ERI, the incision is made carefully and hierarchically in the direction of the mucosal layer to reduce the risk of perforation.…”

A Scarless Healing Tale: Comparing Homeostasis and Wound Healing of Oral Mucosa With Skin and Oesophagus

“…Peptic strictures are caused by gastroesophageal reflux disease when stomach acid damages the oesophagus epithelium over time ( Yamasaki et al, 2016 ). Stricture formation may result from extended endoscopic mucosal resection and submucosal dissection, two techniques used for treatment of superficial gastrointestinal neoplasia, gastric cancer and superficial Barrett’s oesophagus ( Yang et al, 2019 ; Huang et al, 2020 ). The oesophageal stricture may be persistent or recurrent despite application of several therapies.…”