THE EFFICACY AND SAFETY OF THE SECOND ENDOSCOPIC RADIAL INCISION AND CUTTING METHOD FOR REFRACTORY BENIGN ESOPHAGEAL STRICTURE

Aims Benign esophageal strictures after any treatment of esophageal cancer are often refractory to conventional dilation. Radial incision and cutting (RIC) method is indicated for refractory cases and showed the favorable outcome in the short term. However, some cases develop re-stricture in the long term and RIC is tried to perform repeatedly for such cases. As its efficacy and safety have not been reported yet, we aimed to clarify the efficacy and safety of second RIC.

Methods Patients who were treated with first RIC for benign esophageal stricture between April 2012 and September 2019 were enrolled. We used an insulated-tip knife to cut the stricture site and removed the fibrotic tissue of stricture in RIC. According to the number of RIC procedure, all patients were classified into group A (once) and group B (twice or more). We evaluated the one- and 6-month patency rates after RIC procedure, and the adverse events among all first RIC, first RIC and second RIC of patients in group B, retrospectively.

Results We evaluated 39 patients (35 men, 4 women; median age 72 years, range 49-85) who were eligible. The causes of stricture were surgical resection in 30 patients, endoscopic resection in 5 patients, and chemoradiotherapy in 4 patients. RIC were performed once in 23 patients (group A), and twice or more in 16 patients (group B). The one- and 6-month patency rates after first RIC of all patients were 56% and 39%, respectively. In group B, those after first RIC was 50% and 8%, whereas those after second RIC was 63% and 15%. There were no adverse events in all procedures.

Conclusions RIC can be an effective and safe treatment even for patients with refractory benign esophageal stricture after first RIC.