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Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-te



Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study.


DOI: https://doi.org/10.1016/j.gie.2019.12.040


Bram D. Vermeulen, MD, Merle de Zwart, MD, Jasmijn Sijben, BSc, Elsa Soons, MD, Lucie van der Weerd, BSc, Daniele Arese, MD, Daan W. von den Hoff, MD, Vincenzo Craviotto, MD, Adriaan C.I. T.L. Tan, MD, PhD, Marcel J.M. Groenen, MD, PhD, Auke Bogte, MD, PhD, Alessandro Repici, MD, Manon C.W. Spaander, MD, PhD, Peter D. Siersema, MD, PhD / Gastrointestinal Endoscopy, May 2020, Volume 91, Issue 5, Pages 1058–1066

Benign esophageal strictures are characterized by fibrosis of different etiologies, which produce a decrease in organ light, leading to dysphagia. Endoscopic dilation is the mainstay of treatment in these pathologies, which is carried out in sequential sessions, using dilation balloons or probes, until an oesophageal diameter is reached that allows the relief of the symptoms. However, one third of benign stenoses are refractory to this treatment.


This retrospective multicentre study, carried out between March 2003 and October 2018, in which 891 patients were included, aimed to establish the risk factors associated with refractory stenoses, their evolution over the follow-up period and adverse effects.


The mean number of dilations during follow-up was used to define refractoriness to treatment. The mean follow-up was 39 months. In the multivariate analysis of the factors associated with the highest number of dilations (refractoriness) were found in caustic stenoses with a mean of 7.2 dilations and in post-radiation stenoses a mean of 5.0.


A greater number of dilations was needed in patients with a maximum luminal diameter of 13-15 MM reached during the first 3 sessions (mean 5.6) when compared to patients in whom a diameter greater than 16-18MM was reached (mean 4.7). Thus, anastomosis stenosis, radiation stenosis, caustic stenosis and post endotherapy stenosis were associated with a greater number of dilations.


After one year of follow-up 75.2% of the patients with anastomotic stenosis remained free of dilation, 71.2% post-radiation, 83.1% post-endotherapy, 61.9% caustic stenosis.


Adverse effects were reported in 7.1% of the procedures; of these, the most common adverse effects were retrosternal pain (2.7%), perforation (2.4%) and bleeding (1%).


Comment:

"Most of the patients with benign stenosis who remained longer free of dilation after one year of follow-up were those who were dilated from 16 - 18MM, who were associated with fewer dilation sessions", Haydee Alvarado, MD - IECED specialist.




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