Planned supportive bougienage is the basis for complex endoscopic treatment of refractory cicatricial strictures of the esophagus and anastomoses

Abstract

Purpose of the study: the concept of complex endoscopic treatment of refractory benign cicatricial strictures of the esophagus and esophageal anastomoses is outlined, including the methodology of long-term planned supportive bougienage with intramural injections of glucocorticosteroids based on our own extensive experience. The results of an analysis of immediate and first long-term results in this group are presented, as well as detailed recommendations for the management of patients after interventions. Materials and methods. For the period from 2013 to 2023 in the endoscopic department of the Federal State Budgetary Institution “Petrovsky National Research Center of Surgery” 70 patients with refractory cicatricial strictures of the esophagus and anastomoses underwent complex endoscopic treatment, including the main course and long-term planned supportive bougienage, supplemented with intramural injections of Dexamethasone and triamcinolone according to the protocol we developed. Results. Of the total number of patients, 16 (23%) patients, after one or several courses of intramural steroid injections, did not have restenosis for 1 year or more, and 38 (54%) patients required no more than 3 sessions of prophylactic bougienage. In 49 (70%) patients, the duration of treatment was less than 1 year, and the average number of bougienage sessions was from 11 to 20. Conclusion. During the endoscopic treatment of patients with esophageal stenoses of various etiologies and strictures of the esophageal anastomoses, it is very important to assess the refractoriness of the narrowing at an early stage and determine the indications for intramural injections of glucocorticosteroids. Only if all recommendations and a regimen of long-term planned supportive bougienage are followed is it possible to achieve lasting stabilization of the lumen in the narrowing zone and avoid recurrence.