159. NEW ENDOSCOPIC TREATMENT TECHNIQUE TO PREVENT REFRACTORY CORROSIVE ESOPHAGEAL STRICTURES

Abstract

Abstract Refractory esophageal stricture is an undesired complication after caustic ingestion associated with increased morbidity and mortality. Prevention rather than treatment of the stricture is a desirable goal. The objective of this study was to report the safety and outcome of our novel endoscopic technique using Repeated endoscopy with Intraluminal Fibrinous adhesioLysis of the Esophagus (RIFLE) during the first 2 weeks of caustic ingestion aiming to prevent the development of refractory esophageal stricture and bypass surgery. Patients with Zagar’s grade IIb-IIIa corrosive esophageal injury were included. Patients undergoing emergent surgery were excluded. Since 2018, upper endoscopy with lysis of intraluminal fibrinous adhesion by advancing endoscopic tip through the lesions has been gently performed initially at the third day and then repeated twice a week during the first 2 weeks of the ingestion in 15 patients of the study group. Before 2018, a standard ‘wait and see’ treatment with early dilation at 4–6 weeks after injury had been applied only patients with evidence of esophageal stricture. Patients in the standard were 1:1 matched to the study group. A median number of endoscopic RIFLE session was 4, and there was no treatment-related complication in all 15 patients in the study group. Fifteen out of the 102 patients with grade IIb-IIIa esophageal injury in our database with standard treatment were well matched to the study group. At the median follow-up of 30 months, the frequency of esophageal stricture, refractory esophageal stricture, esophageal replacement procedure, and a median number of dilation session between the study and standard treatment group were 4/15 (27%) vs 10/15 (67%), p = 0.02, 1/15(7%) vs 7/15(47%), p = 0.01, 1/15(7%) vs 6/15(40%), p = 0.03, and 4 vs 11, p < 0.001, respectively. In patients with severe non-transmural caustic esophageal injury, repeated endoscopy with intraluminal fibrinous adhesiolysis of the esophagus during the first 2 weeks of the ingestion is safe and associated with decreasing proportion of patients with refractory esophageal stricture and requiring esophageal replacement procedure.