Abstract
BackgroundThe outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking. Our objective was to explore the role of endoscopic dilation and stents placement in the management of RBES.MethodsRBES patients treated with dilation and stents in our hospital between January 2009 and December 2017 were included in this study. The primary outcomes were to assess clinical effectiveness and adverse events. The secondary outcome was to identify factors that predicted the dysphagia-free period.ResultsAmong 75 RBES patients (54 male; median age 59 years), 39 (52%), 20 (26.7%), 3 (4%), 10 (13.3%), and 3 (4%), were postsurgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median number of endoscopic therapy was 5 times (range 3, 21). Endoscopic therapy was successful in 46 patients (61.3%). Patients treated with dilation showed a higher success rate (70.9%, 39/55) than that treated with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The patients treated with dilation demonstrated a dysphagia-free period of 3.7 months (95% CI, 2.7–5), while patients treated with stents displayed a dysphagia-free period of 2.3 months (95% CI, 1.5–3). The dysphagia-free period had a linear growth trend over time, with an increase of 12 days per endoscopic therapy.ConclusionThe dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic therapy tended to be effective in patients with RBES by increasing the dysphagia-free period. However, compared to dilation therapy, stent therapy was not effective in increasing the dysphasia-free period and reducing the times and frequency of dilation. In addition, univariate and multivariate analyses also indicated that etiology may predict the endoscopic therapy outcome.Trial registrationThis study was retrospectively registered and approved by the Ethics Committee of West China Hospital of Sichuan University (IRB number: ChiCTR1800016321).
Highlights
The outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking
Benign strictures of the esophagus include peptic esophageal strictures caused by long-term acid reflux, caustic esophageal strictures, postsurgical esophageal strictures, post-endoscopic submucosal dissection (ESD) esophageal strictures, strictures caused by local radiotherapy, or tuberculosis [1, 2]
Current research confirms that both dilation and stents for RBES are effective, but literature is scarce on the clinical efficacy of dilation versus stents
Summary
The outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking. Our objective was to explore the role of endoscopic dilation and stents placement in the management of RBES. Dilation with bougies or balloons is the classic treatment for esophageal strictures [3], but over 30% of patients need continuing endoscopic dilation for more than 2 sessions during longterm follow-up [4, 5]. Some studies suggest temporary placement of selfexpandable stents for RBES when dilation has failed, though a clear definition of clinical failure has not been uniformly adopted. Patients were followed for 6 months to assess the long-term outcomes, safety, and efficacy of endoscopic therapy in patients with RBES after at least 3 endoscopic therapy sessions
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