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DOI: 10.1055/a-2117-8197
Is a higher frequency of esophageal dilations more effective in treating benign esophageal strictures? Retrospective, multicenter study
Abstract
Background and study aims There is still a lack of evidence-based recommendations concerning endoscopic bougienage in benign esophageal strictures. Our study aimed to assess the relevance of the time interval between endoscopic dilation (ED) sessions with regard to endoscopic and clinical response.
Patients and methods We performed a retrospective study including patients treated with endoscopic bougienage for a benign esophageal stricture in two German centers. Primary endpoint was the number of ED until freedom from dysphagia was achieved. Secondary endpoints were analyses on reaching a diameter of 15 mm and on achieving clinical freedom from symptoms.
Results Between April 2014 and March 2020, bougienage was used as the primary treatment for benign esophageal strictures in 238 patients (194 patients in Center 1; 44 patients in Center 2). Both centers differed in their endoscopic bougienage regime: Center 1 was characterized by a higher frequency of interventions compared to Center 2 (median: 2 days [range 1–28] vs. 10 days [range 1–41]; P<0.001). Clinical response was achieved significantly earlier using the high-frequency regimen in all patients except for those with post-radiogen strictures, who clinically benefited from a low-frequency ED program. Accordingly, patients receiving higher-frequency ED reached a significantly larger post-dilation diameter and considerably larger diameter differences.
Conclusions The results of our study demonstrate that a treatment concept consisting of higher-frequency bougienages seems to be more effective in treating most types of esophageal stricture. Radiogenic strictures were the only types of stenoses that benefited from a lower frequency ED program.
Keywords
Reflux disease - Benign strictures - Endoscopy Upper GI Tract - Dilation, injection, stenting - Malignant stricturesPublication History
Received: 29 November 2022
Accepted after revision: 22 March 2023
Accepted Manuscript online:
26 June 2023
Article published online:
10 January 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Boregowda U. Endoscopic management of benign recalcitrant esophageal strictures. Ann Gastroenterol 2021; 34: 287-299
- 2 Mendelson AH, Small AJ, Agarwalla A. et al. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol 2015; 13: 263-271.e1
- 3 Ravich W. Endoscopic Management of Benign Esophageal Strictures. Curr Gastroenterol Rep 2017; 19: 50
- 4 Pasha SF, Acosta RD. ASGE Standards of Practice Committee. et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc 2014; 79: 191-201
- 5 Sami SS, Haboubi HN, Ang Y. et al. UK guidelines on oesophageal dilatation in clinical practice. Gut 2018; 67: 1000-1023
- 6 Shemesh E, Czerniak A. Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures. World J Surg 1990; 14: 518-521
- 7 Saeed ZA, Ramirez FC, Hepps KS. et al. An objective end point for dilation improves outcome of peptic esophageal strictures: a prospective randomized trial. Gastrointest Endosc 1997; 45: 354-359
- 8 Yamamoto H, Hughes RW, Schroeder KW. et al. Treatment of benign esophageal stricture by Eder-Puestow or balloon dilators: a comparison between randomized and prospective nonrandomized trials. Mayo Clin Proc 1992; 67: 228-236
- 9 Scolapio JS, Pasha TM, Gostout CJ. et al. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc 1999; 50: 13-17
- 10 Rice TW. Dilation of peptic esophageal strictures. Oper Tech Card Thorac Surg 1997; 2: 100-116
- 11 Denzer U, Beilenhoff U, Eickhoff A. et al. S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie (Kurzversion), AWMF Register Nr. 021–022. Z Für Gastroenterol 2015; 53: 1496-1530
- 12 Raymondi R, Pereira-Lima JC, Valves A. et al. Endoscopic dilation of benign esophageal strictures without fluoroscopy: experience of 2750 procedures. Hepatogastroenterology 2008; 55: 1342-1348
- 13 Vermeulen BD, Zwart M de, Sijben J. et al. Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study. Gastrointest Endosc 2020; 91: 1058-1066
- 14 Riley S, Attwood S. Guidelines on the use of oesophageal dilatation in clinical practice. Gut 2004; 53: i1-i6
- 15 Kim JH, Song H-Y, Kim H-C. et al. Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients. J Vasc Interv Radiol JVIR 2008; 19: 736-741
- 16 Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol 2002; 35: 117-126
- 17 van Boeckel PGA, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol 2015; 13: 47-58
- 18 Maple JT, Petersen BT, Baron TH. et al. Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique. Gastrointest Endosc 2006; 64: 822-828
- 19 Alevronta E, Ahlberg A, Mavroidis P. et al. Dose-response relations for stricture in the proximal oesophagus from head and neck radiotherapy. Radiother Oncol J Eur Soc Ther Radiol Oncol 2010; 97: 54-59
- 20 Caudell JJ, Schaner PE, Desmond RA. et al. Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2010; 76: 403-409
- 21 Ahlberg A, al-Abany M, Alevronta E. et al. Esophageal stricture after radiotherapy in patients with head and neck cancer: experience of a single institution over 2 treatment periods. Head Neck 2010; 32: 452-461