Endoscopic Treatment of Benign Esophageal Strictures with Removable or Biodegradable Stents

2011 ◽  
pp. 156-164
Author(s):  
Yvan Vandenplas ◽  
Bruno Hauser ◽  
Thierry Devreker ◽  
Daniel Urbain ◽  
Hendrik Reynaert ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Esophageal Strictures ◽  
Biodegradable Stents

Endoscopic Treatment of Benign Esophageal Strictures with Removable or Biodegradable Stents

2017 ◽  
pp. 1119-1125
Author(s):  
Yvan Vandenplas ◽  
Bruno Hauser ◽  
Thierry Devreker ◽  
Daniel Urbain ◽  
Hendrik Reynaert
Keyword(s):  
Endoscopic Treatment ◽  
Esophageal Strictures ◽  
Biodegradable Stents

PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 76-76
Author(s):  
Keat How Teoh ◽  
Kelvin Voon ◽  
Shyang Yee Lim ◽  
Premnath Nagalingam
Keyword(s):  
Endoscopic Treatment ◽  
Esophageal Stricture ◽  
Endoscopic Dilatation ◽  
Line Treatment ◽  
First Line ◽  
Benign Esophageal Stricture ◽  
Anastomotic Strictures ◽  
Esophageal Strictures ◽  
The Mean ◽  
First Line Treatment

Abstract Background Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia. Methods A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017. Results The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05). Conclusion Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success. Disclosure All authors have declared no conflicts of interest.

scholarly journals Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial

Endoscopy ◽  
2018 ◽  
Vol 50 (12) ◽  
pp. 1146-1155 ◽  
Author(s):  
Daisy Walter ◽  
Maarten van den Berg ◽  
Meike Hirdes ◽  
Frank Vleggaar ◽  
Alessandro Repici ◽  
...  
Keyword(s):  
Stent Placement ◽  
Controlled Trial ◽  
Treatment Algorithm ◽  
Stent Group ◽  
Biodegradable Stent ◽  
Recurrent Stricture ◽  
Level Of Activity ◽  
Number Of Patients ◽  
Esophageal Strictures ◽  
Biodegradable Stents

Abstract Background Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared. Methods This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity. Results At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months (P < 0.001). Conclusion Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES.

Endoscopic stenting of refractory benign esophageal strictures (review)

2021 ◽  
Vol 23 (5) ◽  
pp. 448-452
Author(s):  
Aleksej I. Ivanov ◽  
◽  
Aleksej I. Ivanov ◽  
Aleksej I. Ivanov ◽  
Vladimir A. Popov ◽  
...  
Keyword(s):  
Esophageal Stenosis ◽  
Individual Characteristics ◽  
Endoscopic Stenting ◽  
Current State ◽  
Stent Type ◽  
Anastomotic Strictures ◽  
Esophageal Strictures ◽  
Surgical Methods ◽  
Biodegradable Stents ◽  
Esophageal Stenting

Despite the fact that the overwhelming majority of benign esophageal strictures, although long-term, but effectively stop with the help of endoscopic recanalization, 10% of them recur. Such strictures are a major problem in thoracic surgery. Disabled surgical methods of treatment are associated with a sufficiently high mortality rate and do not guarantee the formation of new anastomotic strictures. Esophageal stenting against the background of a limited endoscopic arsenal of methods for recanalization of benign strictures is the last option. A lot of different models of esophageal stents with their own individual characteristics and features have appeared since the introduction of the first stents in clinical practice. All were investigated in an attempt to identify the optimal stent type and design for the treatment of refractory benign strictures. The review is devoted to the current state of stenting in recurrent benign esophageal stenosis. The review reflects the efficacy and disadvantages of various types of stents and their comparison with a focus on new biodegradable stents used in the treatment of benign esophageal strictures.

Biodegradable stents for caustic esophageal strictures: a new therapeutic approach

2012 ◽  
Vol 26 (3) ◽  
pp. 319-322 ◽  
Author(s):  
T. Karakan ◽  
O. G. Utku ◽  
O. Dorukoz ◽  
I. Sen ◽  
B. Colak ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Esophageal Strictures ◽  
Biodegradable Stents

scholarly journals Triple intramural dexamethasone injections increase the efficiency of endoscopic bougienage of esophageal re-stenosis and anastomosis

2021 ◽  
Vol 1 (5) ◽  
pp. 31-38
Author(s):  
N. A. Bulganina ◽  
E. A. Godzhello ◽  
M. V. Khrustaleva ◽  
M. A. Dekhtyar
Keyword(s):  
Satisfactory Result ◽  
Endoscopic Treatment ◽  
Research Center ◽  
Lumen Diameter ◽  
Standard Algorithm ◽  
Esophageal Strictures ◽  
Long Time ◽  
Biopsy Channel

Purpose of the study. To analyze retrospectively our own experience of using intramural dexamethasone injections during endoscopic bougienage of recurrent or very tight (refractory) benign cicatricial strictures of the esophagus and esophageal anastomoses.Materials and methods. From 2013 to March 2021, this method was applied in 43 patients (26 — men, 17 — women) with peptic (11), cicatricial (8), burn (6) esophageal strictures and strictures of anastomoses (18) prone to restenosis. Dexamethasone was injected into the constricted area with a needle passed through the endoscope biopsy channel as an addition to supportive bougienage.Results. After dexamethasone injections, 41 (95.3%) of 43 patients achieved a satisfactory lumen diameter, at which the symptoms of dysphagia disappeared for a long time without relapse. In most patients, the lumen in the stricture zone stabilized at a diameter of 8–18 mm (average 13 mm). With strictures of the esophagus, it was possible to achieve a diameter of 8–14 mm (average 11 mm), and with strictures of the anastomoses — 10–18 mm (average 14 mm).Conclusion. With the tendency of stricture to restenosis, the standard algorithm for endoscopic bougienage, developed in the endoscopy department of the “Petrovsky National Research Center of Surgery”, was supplemented with intramural injections of dexamethasone. This combined endoscopic treatment made it possible to increase the diameter of the bougie and the intervals between bougienage due to the stabilization of the scar frame and to complete the endoscopic treatment with a satisfactory result in 95.3% of patients.

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