Benign Esophageal Strictures Research Articles

P27 Challenging management of GI complications in Systemic Sclerosis

Introduction/BackgroundSystemic sclerosis is a chronic, progressive, multisystemic autoimmune disease in which there is excessive collagen deposition in the dermis and internal organs. It is commonly categorized into limited cutaneous or diffuse cutaneous systemic sclerosis. In more than 80% of patients there is GI involvement. Gut complications can impair oral intake, absorption and even faecal continence, and consequently can have severe adverse effect on quality of life. With disease progression, management of GI symptoms may become more of a challenge. We present a challenging case of SSs with esophageal involvement along with severe regurgitation who eventually responded to a specific prokinetic.Description/Method70 y/o female initially presented to gastroenterology clinic in 2013 due to dysphagia to solids and was found to have benign fibrotic oesophageal stricture for which she had therapeutic dilatation, (normal biopsy result). Subsequently, she had barium swallow which showed severe regurgitation. Manometry confirmed severely hypo-contractile oesophagus thus she was referred to rheumatology for suspected connective tissue disorder.On initial review, she did not describe typical inflammatory symptoms, scleroderma, sclerodactyly, Raynaud’s phenomenon, digital ulcers, calcinosis, telangiectasia or any other connective tissue features but was diagnosed with limited cutaneous systemic sclerosis due to ANA & anti-centromere antibody positivity, severe oesophageal dysmotility and diagnosis of mild pulmonary hypertension (on right heart catheter studies).Her main disabling SSs symptom was refractory belching, intermittent dysphagia and reflux disease resulting in poor oral intake and resultant malnutrition. She had 4-week trial of antibiotics to treat for presumptive small intestine bacterial overgrowth (SIBO) due to persistent belching but had no evident improvement. She had multiple endoscopies which only showed grade B oesophagitis due to which she remained on high dose PPI (Omeprazole 40mg BD) but showed no recurrent stricture. She was also given dual therapy with Ranitidine 150mg bd but derived no benefit.In Rheumatology clinic she was started on erythromycin 250 mg BD as a pro-kinetic and in liquid form for better tolerability (due to the dysphagia) with gradual but significant improvement of her upper GI symptoms. Switching liquid form to tablets/capsule form via GP resulted in worsening symptoms so was switched back to liquid form. GI symptoms worsened again in 2017 and impression was tachyphylaxis to erythromycin. She was started on trial of another pro-kinetic (metoclopramide) but symptoms continued worsening. In view of this she was started back on liquid erythromycin and her symptoms gradually improved again and has remained stable since.Discussion/ResultsSystemic sclerosis (SSc) is an incurable connective tissue disorder. It is estimated that approximately 90% of patients with SSc have some form of oesophageal involvement. For first three years, this patient’s main symptoms were her upper GI tract issues with reflux and oesophageal dysmotility causing delayed gastric emptying.Considering the severity of her GI symptoms, it was of great importance for her to maintain a regular follow up with gastroenterology team for a regular review of symptoms and repeat investigations as needed such as multiple repeat UGI endoscopy to ensure no recurrence of oesophageal stricture, monitoring of GORD, and hydrogen breath testing.We recommend for patients with severe oesophageal dysmotility to be started on prokinetics early to control GI symptoms and have minimal impact of these on quality of life. Liquid preparation has shown a significant improvement in symptoms in our patient as compared to tablet or capsule form which actually worsened the symptoms.Key learning points/ConclusionDysphagia can be a presenting symptom of systemic sclerosis in some cases. Upper gastro-intestinal symptoms can be severe with significant effect on quality of life.Management of these symptoms can be challenging and may require a combination of treatments.Pro-kinetics mainly erythromycin can have a major positive impact in controlling GI symptoms,Liquid form had better outcome in this case as compared to tablet or capsule form.Poor control of GI symptoms can result in significant malnutrition which is associated with more aggressive disease progression, so GI symptoms management plays a key role in disease control.

334. DEFINITION OF SEVERE BENIGN OESOPHAGEAL STRICTURES AND IDENTIFICATION OF ASSOCIATED RISK FACTORS

Abstract Benign oesophageal strictures (BES) are often easily treated but around 30% progress into recurrent or refractory benign oesophageal strictures (RBES), that need repetitive dilatations. Difficulties of RBES have been widely discussed in the literature, but there is not a well-established consensus regarding the definition of RBES. In this study we wanted to develop a simple definition in relation to aetiology and number of dilatation sessions per stricture. A retrospective study on 242 BES-patients treated with endoscopic dilatation was performed. The primary endpoint was need of further dilatation per procedure, based on total number of dilatation sessions performed and stricture ethology. Univariate and multivariable regression analysis were performed to assess risk factors for RBES. Among 242 patients, 76 had RBES. The need of further dilatation increases with 13% at fifth dilation session and keeps a continuous mean value at 81%. Investigating some aetiologies separately, the point where need increases does vary. The risk of having RBES decreased for distal (Odds Ratio (OR) 0,25 (Confidence interval (CI) 95% 0,09-0,65)) and middle (OR 0,35 (CI 95% 0,13-0,88)) location of the stricture compared to proximal strictures. We propose that a stricture can be defined as RBES when reaching the fifth dilatation session. At that point we also suggest that clinicians should consider additional treatment, in addition to dilatation, in order to resolve the stricture.

Laparoscopic antireflux surgery or PPIs in the management of reflux-related esophageal stricture

BackgroundGastroesophageal reflux disease (GERD) is often associated with esophageal stricture, particularly benign esophageal stricture. We aimed to evaluate the effects of balloon catheter dilation (BD) combined with laparoscopic fundoplication (LF) surgery and proton pump inhibitors (PPIs) in patients with reflux-induced esophageal strictures.MethodsWe retrospectively analyzed 116 patients with reflux-induced benign esophageal strictures who underwent balloon dilatation therapy combined with PPIs (BD-PPIs group, n = 58) and balloon dilatation combined with LF (BD-LF group, n = 58). Patients were followed up for 24 months. The outcomes of the patients were monitored, including clinical success, symptom improvement, adverse events, and the frequency of esophagitis.ResultsAt the latest follow-up, the rate of clinical success was higher in BD-LF group than in BD-PPIs group (80.4% vs. 57.7%, P = 0.011). The patients in the BD-PPIs group required more dilation sessions to achieve successful dilation, as compared to those in the BD-LF group (2.1 ± 1.2 vs. 0.7 ± 0.8, P < 0.001). The DeMeester score, number of reflux episodes for which pH was < 4, and lower esophageal sphincter pressure were significantly better in the BD-LF group than in the BD-PPIs group (all P < 0.001). The incidence of reflux esophagitis was higher in the BD-PPIs group than in the BD-LF group, at 24 months (58.8% vs. 18.2%, P = 0.003).ConclusionsBalloon dilatation with concomitant LF is effective and safe for esophageal stricture secondary to GERD. Moreover, antireflux surgery techniques, such as Nissen or Toupet procedure, should be added for reflux-induced benign esophageal stricture.

Benign esophageal strictures after stent-in-stent placement for spontaneous esophageal perforation

Benign esophageal strictures after stent-in-stent placement for spontaneous esophageal perforation

Efficacy of bougie dilation for normal diet in benign esophageal stricture

Objectives Bougination is one of the first-line treatments in benign esophageal stricture (BES). The aim of the study was to identify clinical and endoscopic factors affecting the achievement of a normal diet with only bougie dilation in patients with BES. Patients and methods Patients treated with only bougination for BES at three hospitals were retrospectively investigated. Data including patient demographics, stricture and procedural characteristics were collected. Clinical success was defined as normal diet without additional procedures for two months after bougination. Clinical success rate and associated factors were assessed. Results A total of 121 patients with BES were included. The most common cause of BES was post-operative stricture (n = 55). Finally, 43 (36%) patients were able to eat a normal diet with only bougination. Of these patients, 42 (97.7%) achieved clinical success in the first three sessions or less. Among causes of stenosis, corrosive injury had the lowest success rate (9/40, 22.5%). Clinical success rate was significantly higher for those with the length of stricture of less than 2 cm (47.2%), those with pre-procedural dysphagia of semi-solid or soft diet (51.3%) and those with dilation of 13 mm or more (46.1%). However, the duration of symptom, the number of previous endoscopic treatments and the location of stenosis were not related to clinical success. Conclusions Normal diet is possible in one-third of BES after bougination alone. Predictable factors for achieving a normal diet were less than four sessions of dilation, short length of stricture, pre-procedural dysphagia status and diameter of dilator.

Innovative Upper Gastrointestinal Stenting: Reboring the Blocked Path

Self-expanding metal stents (SEMS) have been established beyond doubt as an effective tool in the palliative management of malignant gastrointestinal tract strictures. The advent of fully covered retrievable SEMS has allowed its use in benign oesophageal strictures and gastric outlet obstruction, which are traditionally treated with balloon or bougie dilation. Although balloon and bougie dilations are effective, strictures may be refractory, requiring repeated sessions of dilation or complex surgeries. Endoluminal stenting spares the patient from complex surgical procedures and their associated complications. Here, the authors present four cases wherein fully covered SEMS were used as an effective therapy for the restoration of the gastrointestinal lumen in non-malignant conditions.

EP-601 Biodegradable stents for benign oesophageal strictures- a single centre experience

Abstract Biodegradable (BD) stents have been used for the management of various oesophageal strictures (ES). The present study aim to evaluate our experience and efficacy of BD stents in benign ES at the endoscopic unit at the James Cook University Hospital, Middlesbrough, UK. Methods A retrospective review of case notes of 9 patients who have undergone endoscopically placement of BD stent for benign ES between March 2010 and November 2020. All 9 patients underwent successful stent placement. None of the patients had previous surgery for their condition. All patients, prior to stenting had oesophageal dilatations, some multiple times. Results Stent placement was successful in all 9 patients. Some patients had stent migration and subsequent re stenting. All patients had benign ES as the cause of dysphagia. One patient had caustic oesophageal stricture, remaining eight had peptic ulceration and GORD as the cause of dysphagia. The median number of dilatations prior to stent placement was 4 (IQR 7), more than the median number of dilatations post stent placement which was 2.0 (IQR: 3.5). Conclusion BD stents offers prolonged dilatation-free interval and reduces the number dilatations in patients with benign oesophageal strictures.

Benign Esophageal Stricture

Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esophageal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thorough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures.

Inversion technique under fluoroscopy for removal of self-expanding nitinol esophageal stent after long-term placement: review of 107 consecutive cases.

Removal of self-expanding esophageal metal stents that have been implanted for a long time can be difficult and risky. In this paper, we describe the use of the "inversion technique" under fluoroscopy for removal of self-expandable nitinol esophageal stents that have been placed for long periods and evaluate the effectiveness and safety of the method. Retrospective analysis of patients who underwent removal of self-expanding nitinol esophageal stents by the inversion technique under fluoroscopy at our center. Demographic characteristics, type of esophageal stents, stent retention time, reasons for stent removal, and related complications were collected from the case records and analyzed. A total of 112 metal esophageal stents (62 fully covered esophageal stents and 50 partially covered esophageal stents) were extracted from the 107 patients included in the study. Indications for stent implantation were malignant esophageal stenosis (27 patients), benign esophageal stenosis (42 patients), and esophageal fistula (38 patients). Median duration of stent retention was 77days (29-727days). All stents were removed successfully without major complications such as esophageal rupture, massive hemorrhage, asphyxia, or cardiorespiratory arrest. Inversion technique under fluoroscopy appears to be a safe, effective, and quick procedure for removal of self-expanding nitinol esophageal stent after long-term placement.

BOUGIE DILATATION IN BENIGN ESOPHAGEAL STRICTURES: EVALUATION OF ADJUVANT METHYLPREDNISOLONE INJECTION

Objective: Mechanical dilatation and adjuvant injection of triamcinolone acetate (TA) effectively preserve the opening provided and reduce the number of bougie dilation (BD) in benign esophageal strictures. In this study, we aimed to evaluate the role of Methylprednisolone (MP) injection after BD in providing permanent/long-term lumen opening. Materials and Methods: Among 22 patients diagnosed with benign esophageal strictures (BES) between January 2017 and October 2020, we evaluated the results of 8 patients who continued the endoscopic follow-up program and underwent BD and MP injection, then compared with the literature. Results: We treated 8 patients [6 (75%) women, mean age 61±16.9 years (range 22-77)] with strictures of different etiologies (3 anastomotic, 2 iatrogenic esophageal rupture repairs, 2 recurrent webs, and 1 scleroderma) with BD followed by intralesional MP injection. We performed median BD sessions 3.5 times (range 1-8). We gave a median 3 intralesional MP injection (range 1-7). The median time to resolve stricture was 2.5 months (range 1-4). The median endoscopic follow-up time was 4.5 months (range 1-17). Conclusions: Adjuvant MP injection is successful in preserving the lumen patency provided after mechanical dilatation. Randomized controlled studies are needed to determine the steroid type and dose to provide the most optimal permanent lumen opening with lesser dilatation sessions in BES.

Biodegradable PTX-PLGA-coated magnesium stent for benign esophageal stricture: An experimental study

Biodegradable stents can degrade step by step and thereby avoid secondary removal by endoscopic procedures in contrast to metal stents. Herein, a biodegradable composite stent, a magnesium (Mg)-based braided stent with a surface coating of poly (lactic-co-glycolic acid) (PLGA) containing paclitaxel (PTX), was designed and tested. By adding this drug-loaded polymer coating, the radial force of the stent increased from 33 Newton (N) to 83 N. PTX was continuously released as the stent degraded, and the in vitro cumulative drug release in phosphate-buffered saline for 28 days was 115 ± 13.5 μg/mL at pH = 7.4 and 176 ± 12 μg/mL at pH = 4.0. There was no statistically significant difference in the viability of fibroblasts of stent extracts with different concentration gradients (P > 0.05), while the PTX-loaded stents effectively promoted fibroblast apoptosis. In the animal experiment, the stents were able to maintain esophageal patency during the 3-week follow-up and to reduce the infiltration of inflammatory cells and the amount of fibrous tissue. These results showed that the PTX-PLGA-coated Mg stent has the potential to be a safe and effective approach for benign esophageal stricture. Statement of significanceWe designed a biodegradable composite stent, having poly (lactic-co-glycolic acid) (PLGA) containing paclitaxel (PTX) coated the surface of the magnesium (Mg)-based braided stent. We evaluated in vitro and in vivo characteristics of the Mg esophageal stent having a PLGA coating plus a variable concentration of PTX in comparison with the absence of PTX PLGA coating. The PTX PLGA stents exerted higher radial force than stents without coating, degraded more quickly in an acid medium, and effectively promoted fibroblast apoptosis in vitro experiments. In a rabbit model of caustic-induced esophageal stricture, there was an increased lumen and decreased inflammation of the esophageal wall in the animals stented with PTX-PLGA versus the sham group, indicating a potential approach for benign esophageal stricture.

Clinical outcomes on weekly endoscopic dilations as the initial approach to manage patients with complex benign esophageal strictures: report on 488 dilations.

Success rate of endoscopic dilation (ED) of complex benign esophageal strictures (CBES) can be as low as 65%. Since EDs are usually performed at 2-4-week intervals, the aim of this study was to evaluate the clinical outcomes of EDs done initially at weekly intervals. A cohort of patients with CBES (luminal diameter < 10mm) underwent ED at weekly intervals and subsequent dilation intervals adjusted based on response. Weekly EDs were also re-initiated in those requiring additional interventions (electro-cautery/stents). Group A patients: Failed prior EDs done at ≥ 2-week intervals. Group B: CBES with no prior dilations. Success was defined as achieving and maintaining a luminal diameter of ≥ 14mm and patient remaining dysphagia-free with minimal re-interventions. 488 EDs were performed on a cohort of 57 consecutive patients with CBES. Median follow-up was 4years. Group A: 21 patients (mean age 65 ± 13years; mean interval between prior failed dilations 17 ± 9days). 57% of these patients achieved long-term success with weekly dilations (mean 8 ± 4.7 dilations/patient). Group B: 36 patients (mean age 61 ± 13years, mean 6.5 ± 5.5 dilations/patient). Long-term success was 83.3% (P = 0.033). Despite weekly dilations, unable to achieve a diameter of 14mm in 5 patients. AE: perforation 1 (0.2%), bleeding 1 (0.2%). Significant proportion of patients with CBES who failed prior dilations done at ≥ 2-week intervals achieved dysphagia-free status by initiating weekly dilations. Hence, before considering other options (electro-cautery/stents), one can consider using this approach. This approach can also be used upfront in patients with newly diagnosed CBES.

Local injection of botulinum toxin type A (BTX-A) prevents scarring esophageal stricture caused by electrocautery in rabbit models.

BackgroundBenign esophageal strictures are common in clinical practice. The commonly used methods for preventing benign esophageal strictures still have many shortcomings. In this study, we investigated the preventive effect and possible mechanism of endoscopic local injection of botulinum toxin type A (BTX-A) on scarring esophageal stricture caused by electrocautery in rabbit models, with an attempt to provide a theoretical basis for the clinical application of BTX-A in the prevention of benign esophageal stricture.MethodsAdult male New Zealand rabbits were randomly divided into 4 groups: cautery group (cauterized with 30 W electrocoagulation power without other intervention), saline group (injected with normal saline at 4 spots in the local esophagus after modeling), BTX-A I group (injected with 10 U of BTX-A after modeling), and BTX-A II group (injected with 20 U of BTX-A after modeling). Body weight was measured at postoperative weeks 1, 2, and 4. Esophagography was performed, and the internal diameter of the esophagus was measured. The esophageal tissues were harvested for hematoxylin and eosin (HE) staining and Masson staining. Type I, type III collagen levels and the mRNA expression of transforming growth factor β1 (TGF-β1) in esophageal tissues were detected.ResultsCompared with the cautery and saline groups, the BTX-A I and BTX-A II groups had significantly higher body weight, larger esophageal internal diameter, lower type I and type III collagen levels, and lower TGF-β1 mRNA expression levels in esophageal tissues at postoperative week 4. Comparisons between the BTX-A I and BTX-A II groups showed no significant differences in terms of body weight, esophageal internal diameter, and type I collagen level at postoperative week 4. However, the BTX-A II group had a significantly lower type III collagen level and TGF-β1 mRNA expression level than the BTX-A I group.ConclusionsLocal injection of BTX-A can alleviate esophageal stricture after electrocautery and has a preventive effect on benign esophageal stricture caused by electrocautery in rabbits. The mechanism may be that BTX-A down-regulates the expression of TGF-β1 in the esophageal tissue at the burn site and reduces the deposition of collagen.

Fluoroscopy-guided balloon dilatation of benign esophageal strictures in children: 11-year experience.

The esophageal stricture is an important clinical problem in children, and the treatment is difficult. To evaluate the results of fluoroscopy-guided balloon dilatation of benign pediatric esophageal strictures and to suggest a safety range for balloon diameters. We retrospectively reviewed the medical records of children who underwent fluoroscopy-guided esophageal balloon dilatation for treatment of benign esophageal stricture from February 2008 to July 2019. We recorded the demographic data of the children, technical details of each procedure, balloon diameter, number of repeated procedures, clinical and technical success rates, complications and follow-up period. Technical success was defined as the disappearance of the waist formation on the balloon catheter, and clinical success was defined as no need for re-dilation or other treatment methods during the 1-year follow-up after the procedure. These children were divided into groups and evaluated according to esophageal stricture etiology. Technically successful procedures included 375 balloon dilatations in 116 patients (67 boys; age range: 1month to 18years; mean age: 4.3 ± 4.8 standard deviation [SD] years at the initial dilatation). The follow-up period was 1-138months (median: 41months; mean: 44months) since the last dilatation. In this study, the clinical success rate was 34% per procedure (120 of 353 procedures) and 85% per patients (91 of 107 patients). The total complication rate per procedure was 0.5%, and the perforation rate was 0.25% per session. Fluoroscopy-guided esophageal balloon dilatation is an effective and reliable method for treating benign esophageal strictures in children.

Endoscopic cryotherapy: Indications, techniques, and outcomes involving the gastrointestinal tract.

Endoscopic cryotherapy is a technique utilized for the ablation of target tissue within the gastrointestinal tract. A cryotherapy system utilizes the endoscopic application of cryogen such as liquid nitrogen, carbon dioxide or liquid nitrous oxide. This leads to disruption of cell membranes, apoptosis, and thrombosis of local blood vessels within the target tissue. Several trials utilizing cryotherapy for Barrett’s esophagus (BE) with variable dysplasia, gastric antral vascular ectasia (GAVE), esophageal carcinoma, radiation proctitis, and metastatic esophageal carcinomas have shown safety and efficacy. More recently, liquid nitrogen cryotherapy (cryodilation) was shown to be safe and effective for the treatment of a benign esophageal stricture which was refractory to dilations, steroid injections, and stenting. Moreover, liquid nitrogen cryotherapy is associated with less post procedure pain as compared to radiofrequency ablation in BE with comparable ablation rates. In patients with GAVE, cryotherapy was found to be less tedious as compared to argon plasma coagulation. Adverse events from cryotherapy most commonly include chest pain, esophageal strictures, and bleeding. Gastric perforations did occur as well, but less often. In summary, endoscopic cryotherapy is a promising and growing field, which was first demonstrated in BE, but the use now spans for several other disease processes. Larger randomized controlled trials are needed before its role can be established for these different diseases.

Endoscopic stenting for stenosing cancer and digestive canal structures

Background. The purpose of the work was to evaluate the effectiveness of the endoscopic stenting method in stenosing cancer and strictures of the digestive tract. Materials and methods. Since January 2015, endoscopic stenting has been performed in 12 patients using self-expanding nitinol stents with/without polymer coating manufactured by Boston Scientific, Ltd (USA) and uncoated nitinol stents manufactured by Garson (Korea). The study included 8 men (66.7 %) and 4 women (33.3 %) aged 51–80 years, (63.0 ± 4.2) years on average. Stenosing esophageal cancer was diagnosed in 5 patients, stenosing cancer of the gastric outlet— in 3, stenosing duodenal cancer — in one, esophageal stricture — in 3 people. In all patients, the indication for stenting was impaired patency of the digestive tract due to the underlying di-sease. Results. Nutrition was restored in all patients. In the group of stenosing esophageal cancer, the 30-day mortality rate was 20%, the median survival rate was 9 months. Recurrence of dysphagia was diagnosed in one person, recanalization of the stent lumen was performed. In the group with stenosing cancer of the gastric outlet and duodenum, the 30-day mortality rate was 33.3%, the median survival rate was 11 months. Impaired gastric emptying was detected in one patient, repeated stent-to-stent stenting was performed. In the group with esophageal stricture, one individual had stent migration, so the stent was repositioned. Conclusions. Endoscopic stenting with self-expanding nitinol stents in incurable patients with malignant stenoses of the esophagus, stomach, duodenum and in those with benign esophageal strictures is the surgery of choice, a safe and effective method that allows you to restore and continue natural nutrition and thereby improve the quality of life in incurable cases. Complications arising in the late period after stenting were found in 25 % of patients, and were corrected endoscopically.

Benign Stenosis of Oesophagus: About 101 Cases in the Digestive Endoscopy Department of the General Idrissa Pouye Hospital (Dakar, Senegal)

Introduction: Benign oesophageal strictures are defined as narrowing of the oesophageal lumen not related to neoplastic pathology. They are frequently encountered during endoscopic practice and are often responsible for a reduction in the quality of life of patients due to the appearance of dysphagia. In sub-Saharan Africa, little data are available on these benign esophageal strictures. The objective of our study was to determine the sociodemographic, diagnostic and therapeutic aspects of benign oesophageal strictures in a digestive endoscopy centre in Senegal. Patients and Methods: This was a retrospective, descriptive study analysing reports of upper GI endoscopies performed between January 2015 and December 2017 in a hospital in Senegal. Reports that concluded to have non-neoplastic oesophageal stenosis were collated. Sociodemographic data, indications for and results of endoscopy, and therapeutic modalities were collected. These data were analysed using the Sphinx version 5 software. Results: We collected 101 cases of benign oesophageal stenosis, representing a prevalence of 2.1% in the endoscopy centre. The mean age of the patients was 34 years (range 2 and 83 years) with a median of 37.9 years. There was a female predominance with a sex ratio of 0.38 (73 females). Dysphagia, the main symptom, was present in 87 patients (86.1% of cases) with a Dysphagia score greater than or equal to 2 in 51 patients (50.5%). The average duration of this dysphagia, excluding caustic stenosis, was 4 years (extremes 1 and 15 years). Endoscopy revealed simple stenosis in 76 cases (75.2% of cases). A membranous ring of the cervical oesophagus, suggestive of the Plummer-Vinson syndrome ring, was found in 60 patients (59.4% of cases) and was the primary cause; other aetiologies were dominated by caustic stenosis (19 cases), Schatzki rings (8 cases) and peptic stenosis (4 cases). Endoscopic dilatation was performed in 90 patients (89.1% of cases) with Savary Gilliard bougies (87 cases) and hydrostatic balloons (3 cases). The average number of dilatation sessions was 1.69. In 10 patients (11.1%), refractory stenosis was observed. This stenosis could be resolved after further dilatation in 8 cases before the 8th session. In 2 patients, dilatation failed. Conclusion: Benign oesophageal strictures in our digestive endoscopy centre in Senegal mainly affect young adults, with a predominance of women. Diagnosis is often late. Cervical oesophageal rings in the context of Plummer-Vinson syndrome are the main cause. Oesophageal dilatation with bougies is of great therapeutic value.

ИНТРАМУРАЛЬНЫЕ ИНЪЕКЦИИ ТРИАМЦИНОЛОНА (КЕНАЛОГ) В ЭНДОСКОПИЧЕСКОМ ЛЕЧЕНИИ СЛОЖНЫХ РУБЦОВЫХ СТРИКТУР ПИЩЕВОДА И АНАСТОМОЗОВ

Abstract. Approximately one third of patients with complex strictures of the esophagus and esophageal anastomoses develop restenosis after a course of endoscopic bougienage. To prevent this, we have developed a tactic of long-term planned maintenance bougienage for 6-24 months, which is successfully used in the clinical practice of the endoscopy department of the Petrovsky National Research Center of Surgery for many years. Recently, to improve the results of endoscopic bougienage of refractory benign esophageal and esophageal anastomotic strictures and strictures with the tendency to restenosis or recurrence, we have been using intramural steroid injections according to our scheme. To date, the technique has been applied in 65 patients (esophageal strictures — 44, strictures of esophageal anastomoses — 21). Comparison of the immediate results of endoscopic bougienage, supplemented by the introduction of Dexamethasone and Kenalog, showed the advantage of the latter. There were no complications of intramural steroid therapy in the course of endoscopic bougienage. Our still little experience with the use of intramural injections of triamcinolone acetate (Kenalog) in the course of long-term planned endoscopic bougienage of complex recurrent and refractory strictures of the esophagus and esophageal anastomoses indicates that this technique is promising.

Contactless Measurement of Integrity of Silicone Coating on Self-Expandable Esophageal Nitinol Stents.

A stent is a mesh tube inserted into a natural passage in the body to prevent disease induction. Self-expandable esophageal nitinol stents such as SX-ELLA Stent Esophageal HV (HV Stent Plus) can be indicated for palliation of malignant esophageal strictures, for the treatment of benign esophageal strictures that are refractory to standard therapy and for the treatment of esophago-respiratory fistulas. A silicone-stent coating is used for tumor in-growth prevention and esophago-respiratory fistula occlusion. The thickness of the stent and the overall integrity of the silicone coating of all wires indicate the overall mechanical properties of the esophageal stent and the resistance to external adverse events such as corrosion and mechanical and chemical resistance. The polymer multicomponent epoxy resin - a mixture of Epon and Durcupan - was used as a method for robust sample stabilization. A cutting system using a thin water beam with a powder (Blue Line) was chosen as the best variant to obtain 6 samples for both-sided measurement (10 measuring sides). The optical microscopic reflective light method was used to examine wire crossing points in the sections. Fifty values were measured on either sample side for the internal, external and mesh thickness of the silicone stent layer. The wire crossing points were selected so that the silicone layer structure could be clearly seen, and the wires approached each other most closely. Only approximately 4 to 8 crossing points in each section could be measured when applying this approach. The resolution of the microscope and calibration (based on the camera used) was 0.677 μm/pixel. Additional data could be obtained on 8 planes. Two boundary samples were destroyed by the cutting process. Whole coating of the stent was around all mesh wires, especially in areas with higher mechanical stress (wire crossing). The minimum detectable and admissible value determined for all 3 measuring areas (internal, external, mesh) on the wire crossings was 6.77 μm, i.e., 10 pixels, based on the microscope resolution and manufacturer's methodology. The results were characterized by p < 0.001 for all 3 parameters. We tested opposite samples in each section to verify the section quality and data consistency. For the 4 areas, the data were significantly different, but the thickness differences were only on the order of units percent, so the measurements were not appreciably affected. We assume that the material cutting loss, making up 1-2 mm, contributed to the differences in the sections. We examined the overall integrity of the silicone coating of the esophageal stent. The method of HV stent anchoring in a polymeric bath followed by cutting with a waterjet and sample measurement under an optical microscope proved to be very simple and reliable. Sufficient thicknesses of the silicone layer on the wire cross sections were verified. The coated silicone layer thickness appeared to be significantly different along the stent from the proximal part to the distant part, presumably due to the manufacturing technology.

Protective effect of rosuvastatin against the formation of benign esophageal stricture.

Benign esophageal strictures result from caustic or radiation injury or surgical procedures. Statins have anti-inflammatory and anti-fibrotic activities. We examined the role of rosuvastatin in preventing benign esophageal fibrosis and stricture formation in a rabbit model. Twenty-six rabbits were assigned to control and rosuvastatin groups. The rabbits in the rosuvastatin group were administered rosuvastatin 5mg/day, 2weeks prior to the esophageal stricture phase. Esophageal strictures were established by applying 4% sodium hydroxide solution to the middle esophagus. Esophagography was performed to evaluate the degree of esophageal stenosis, and histopathologic assessment of esophageal tissue damage was performed with hematoxylin-eosin and Masson staining. The expressions of transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), and α-smooth muscle actin (α-SMA) were examined by immunohistochemistry. The incidence of strictures was significantly lower in the rosuvastatin group. Esophagography demonstrated mild stenosis in the narrowest inner esophageal diameter in the rosuvastatin group than in the control group, and Masson staining demonstrated significantly less collagen deposition in the rosuvastatin group. In addition, immunohistochemistry results showed that the expressions of TGF-β1, CTGF, and α-SMA significantly reduced in the rosuvastatin group. The present study demonstrated that rosuvastatin prevents benign esophageal stricture formation. This effect may be exerted through the anti-fibrotic activity of rosuvastatin, which may be exerted by the inhibition of CTGF and α-SMA production induced by TGF-β1.