Sa1608 Radial Incision and Cutting (RIC) Method Is More Effective Than Continued Endoscopic Balloon Dilation (EBD) for Refractory Anastomotic Stricture: A Comparative Study

Esophageal stent complications include stent migration, tumor ingrowth, perforation, a broncho-esophageal fistula, and gastroesophageal reflux. Development of a new stricture at a flange site after stent removal has been predicted but not yet reported. We experienced the first case of a recurrent esophageal stricture induced by a stent flange after stent removal. A fully covered metallic stent, which had been inserted 2 months ago for treatment of an anastomotic stricture, triggered another stricture at the flange site. Although endoscopic balloon dilatations were repeated several times and then the 2nd stent for rescue therapy was inserted, the stricture was refractory to all treatment. Thus, we prescribed oral prednisolone with repeated endoscopic balloon dilation; the stricture eventually improved. The oral steroid seemed to suppress stricture development. If a stent flange-induced refractory stricture is encountered, an oral steroid combined with endoscopic balloon dilation may be helpful.

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Radial incision and cutting for dilation before endoscopic submucosal dissection in patients with esophageal cancer on the distal side of severe benign esophageal strictures

Diseases of the Esophagus ◽

10.1093/dote/doaa092 ◽

2020 ◽

Author(s):

Keiichiro Nakajo ◽

Yusuke Yoda ◽

Tomohiro Kadota ◽

Tatsuro Murano ◽

Kensuke Shinmura ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Balloon Dilation ◽

Endoscopic Balloon Dilation ◽

Submucosal Dissection ◽

Radial Incision ◽

Distal Side ◽

Dilation Group ◽

Esophageal Squamous Cell Carcinomas ◽

Procedural Success ◽

Endoscopic Balloon

ABSTRACT We investigated the efficacy and safety of radial incision and cutting as a novel dilation method for strictures just before endoscopic submucosal dissection in patients with metachronous esophageal cancer localized on the distal side of strictures and determined the optimal dilation method. Consecutive patients who underwent endoscopic submucosal dissection for superficial esophageal squamous cell carcinomas localized on the distal side of severe strictures were investigated retrospectively and assigned to a radial incision and cutting (19 patients; 23 lesions) or an endoscopic balloon dilation (20 patients; 20 lesions) group. We evaluated the passage success rates of cap-wearing endoscopes with diameters ≥8.9 mm, the procedural success, en bloc resection, complete resection, major adverse event rates, and total procedure times. Compared to the endoscopic balloon dilation group, the passage success rate of a conventional endoscope with a transparent cap (87% vs. 50%) and procedural success rate (96% vs. 63%) were significantly higher in the radial incision and cutting group. The mean procedure time of ‘dilation and ESD’ was significantly shorter in the radial incision and cutting group than in the endoscopic balloon dilation group. Neither group experienced any serious adverse events. Radial incision and cutting followed by endoscopic submucosal dissection was effective and safe in patients with superficial esophageal squamous cell carcinomas localized on the distal side of severe benign esophageal strictures. Endoscopic submucosal dissection using a cap-wearing endoscope was possible with radial incision and cutting, and the procedure time was shorter than that for endoscopic balloon dilation.

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