Kosin Med J.  2022 Dec;37(4):291-298. 10.7180/kmj.22.128.

Comparison of the efficacy and complications of endoscopic incisional therapy and balloon dilatation for benign esophageal strictures

• Choi EJ
• Jee SR
• Lee SH
• Kim JH
• Yoon JS
• Heo JH
• Yu SJ
• Baek HW
• Lee HS

• KMID: 2538860
• DOI: http://doi.org/10.7180/kmj.22.128

Abstract

Background
Benign esophageal strictures are treated endoscopically, often with balloon dilatation (BD) or bougie dilators. However, recurrent esophageal strictures have been reported after BD, and severe complications sometimes occur. The aim of this study was to compare the efficacy and complications of endoscopic incisional therapy (EIT) and BD for benign esophageal strictures.
Methods
We retrospectively reviewed patients who underwent BD or EIT as primary treatment for benign esophageal strictures between July 2014 and June 2021. Technical success was defined as restoration of the lumen diameter with <30% residual stenosis. Clinical success was defined as no recurrence of dysphagia within 1 month after BD or EIT and an increase of 1 grade or more on the Functional Oral Intake Scale.
Results
Thirty patients with benign esophageal stricture were enrolled. There were 16 patients in the BD group and 14 patients in the EIT group. No significant differences in technical and clinical success rates were found between the two groups. Furthermore, no significant differences in the re-stricture rate were observed between the groups. There was one complication in the EIT group and three complications in the BD group. Three patients who underwent BD had re-stricture and underwent EIT thereafter, and we regrouped patients who underwent EIT at least once. The clinical success rate was significantly higher in patients regrouped to the EIT group than in patients who underwent BD only.
Conclusions
EIT is not inferior to BD as the primary treatment for benign esophageal strictures, especially for recurrent cases.

Keyword

Dysphagia; Esophageal stricture; Stenosis

Figure

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  Fig. 1. Flowchart of the study population. BD, balloon dilatation; EIT, endoscopic incisional therapy.

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  Fig. 2. Technique of endoscopic incisional therapy for esophageal strictures. (A) Esophageal stenosis before treatment. (B) Arrows depict the radial direction of the incision. (C) Outcome of the procedure. (D) Endoscopic findings of the esophageal stricture ring. (E) Radial incisions using an insulated-tip knife, which were made parallel to the longitudinal axis of the stricture ring.

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  Fig. 3. Flowchart of stricture events in the study population.

Reference

References

1. Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I. Radiologic diagnosis of benign esophageal strictures: a pattern approach. Radiographics. 2003; 23:897–909.

2. Shah JN. Benign refractory esophageal strictures: widening the endoscopist’s role. Gastrointest Endosc. 2006; 63:164–7.

3. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012; 7:287–98.

4. ASGE Standards of Practice Committee, Pasha SF, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014; 79:191–201.

5. Desai JP, Moustarah F. Esophageal stricture [Internet]. Treasure Island: StatPearls Publishing;2022. May. 5. [cited 2022 Sep 12]. https://pubmed.ncbi.nlm.nih.gov/31194366/.

6. Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol. 2002; 35:117–26.

7. Fugazza A, Repici A. Endoscopic management of refractory benign esophageal strictures. Dysphagia. 2021; 36:504–16.

8. Chung WC, Paik CN, Lee KM, Jung SH, Chang UI, Yang JM. The findings influencing restenosis in esophageal anastomotic stricture after endoscopic balloon dilation: restenosis in esophageal anastomotic stricture. Surg Laparosc Endosc Percutan Tech. 2009; 19:293–7.

9. Pierie JP, de Graaf PW, Poen H, van der Tweel I, Obertop H. Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy. Br J Surg. 1993; 80:471–4.

10. Fan Y, Song HY, Kim JH, Park JH, Ponnuswamy I, Jung HY, et al. Fluoroscopically guided balloon dilation of benign esophageal strictures: incidence of esophageal rupture and its management in 589 patients. AJR Am J Roentgenol. 2011; 197:1481–6.

11. Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: technique and results. World J Gastrointest Endosc. 2015; 7:1318–26.

12. Lee TH, Lee SH, Park JY, Lee CK, Chung IK, Kim HS, et al. Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture. Gastrointest Endosc. 2009; 69:1029–33.

13. Hordijk ML, van Hooft JE, Hansen BE, Fockens P, Kuipers EJ. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc. 2009; 70:849–55.

14. Li J, Zhao H, Ma Z, Liu B. Endoscopic incision and selective cutting for primary treatment of benign esophageal anastomotic stricture: outcomes of 5 cases with a minimum follow-up of 12 months. Ann Palliat Med. 2020; 9:1206–10.

15. Jie MM, Hu CJ, Tang B, Xie X, Lin H, Yu J, et al. Circular incision and cutting, a novel treatment for patients with esophageal cancer with anastomotic stricture after esophagectomy. J Dig Dis. 2019; 20:25–30.

16. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a Functional Oral Intake Scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005; 86:1516–20.

17. Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endosc. 2009; 70:1000–12.

18. Weintraub JL, Eubig J. Balloon catheter dilatation of benign esophageal strictures in children. J Vasc Interv Radiol. 2006; 17:831–5.

19. Dehghani SM, Honar N, Sehat M, Javaherizadeh H, Shahramian I, Kalvandi G, et al. Complications after endoscopic balloon dilatation of esophageal strictures in children: experience from a tertiary center in Shiraz: Iran (Nemazee Teaching Hospital). Rev Gastroenterol Peru. 2019; 39:7–11.

20. Brandimarte G, Tursi A. Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery. Endoscopy. 2002; 34:399–401.

21. Simmons DT, Baron TH. Electroincision of refractory esophagogastric anastomotic strictures. Dis Esophagus. 2006; 19:410–4.

22. Pregun I, Hritz I, Tulassay Z, Herszenyi L. Peptic esophageal stricture: medical treatment. Dig Dis. 2009; 27:31–7.

23. Pih GY, Kim DH, Na HK, Ahn JY, Lee JH, Jung KW, et al. Comparison of the efficacy and safety of endoscopic incisional therapy and balloon dilatation for esophageal anastomotic stricture. J Gastrointest Surg. 2021; 25:1690–5.

24. Kim JH, Song HY, Kim HC, Shin JH, Kim KR, Park SW, et al. Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients. J Vasc Interv Radiol. 2008; 19:736–41.

25. Tustumi F, Seguro FC, Szachnowicz S, Bianchi ET, Morrell AL, da Silva MO, et al. Surgical management of esophageal stenosis due to ingestion of corrosive substances. J Surg Res. 2021; 264:249–59.

26. Martins RK, Ribeiro IB, DE Moura DT, Hathorn KE, Bernardo WM, DE Moura EG. Peroral (poem) or surgical myotomy for the treatment of achalasia: a systematic review and meta-analysis. Arq Gastroenterol. 2020; 57:79–86.