Endoscopic treatment of benign esophageal strictures: a literature review

Poincloux, Laurent; Rouquette, Olivier; Abergel, Armand

doi:10.1080/17474124.2017.1260002

Cited by 43 publications

(44 citation statements)

References 109 publications

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“…In these series, all but 4 patients (from the Altintas’ study) who underwent steroid injection of the stricture had peptic injury (25 patients in total) (61, 62). The efficacy of steroid injection as adjunctive treatment remains unclear in other types of benign strictures (63). Apart from encouraging results reported in uncontrolled studies (59), well-designed studies showed mixed findings.…”

Section: Treatmentmentioning

confidence: 99%

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

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Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

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Section: Treatmentmentioning

confidence: 99%

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

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“…Complex strictures, however, are difficult to treat being longer (> 2 cm), angulated or with severely stenosed lumen [2]. Approximately 20 % to 30 % of benign strictures can become refractory to endoscopic dilation, and as many as 50 % in cases of corrosive strictures [3]. Factors determining response to endo-therapy have been the point of much research.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Other symptoms can be atypical chest pain, heartburn and odynophagia. BRES significantly impair the quality of life and may cause severe complications, most importantly weight loss due to malnutrition, but aspiration and regurgitation may occur too[ 3 ]. Patients with BRES need regular endoscopic dilations and it is not uncommon that the stricture recurs in days or weeks, necessitating frequent repeat procedures, in some cases multiple times a month.…”

Section: Introductionmentioning

confidence: 99%

Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis

Szekeres

Tinusz

Farkas

et al. 2018

WJG

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AIMTo analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.METHODSA comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the random-effects method of DerSimonian and Laird. Heterogeneity of the studies was tested by Cochrane’s Q and I2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.RESULTSEleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index (PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group (MD: -1.12 dilation/month, 95%CI: -1.99 to -0.25 P = 0.012; I2 = 74.4%). The total number of repeat dilations (TNRD) was comparable in 5 studies and showed a non-significant decrease (MD: -1.17, 95%CI: -0.24-0.05, P = 0.057; I2 = 0), while the dysphagia score (DS) was comparable in 5 studies and did not improve (SMD: 0.35, 95%CI: -0.38, 1.08, P = 0.351; I2 = 83.98%) after intralesional steroid injection.CONCLUSIONIntralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research.

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Endoscopic treatment of benign esophageal strictures: a literature review

Cited by 43 publications

References 109 publications

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

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

Intralesional steroid is beneficial in benign refractory esophageal strictures: A meta-analysis

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