Format

Send to

Choose Destination
Dysphagia. 2019 Mar 30. doi: 10.1007/s00455-019-10004-1. [Epub ahead of print]

Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies.

Author information

1
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. dr_kochhar@hotmail.com.
2
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
3
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Abstract

BACKGROUND AND AIMS:

This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).

MATERIALS AND METHODS:

Patients with anastomotic strictures (enrolled during January 1996-December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.

RESULTS:

Of the 142 patients, 124 (mean age-44.02; males-74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2-10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.

CONCLUSION:

Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.

KEYWORDS:

Caustic anastomotic strictures; Deglutition; Deglutition disorders; Endoscopic dilation; Recurrent stricture; Refractory stricture

PMID:
30929058
DOI:
10.1007/s00455-019-10004-1

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center