Endoscopic Treatment of Postradiation Strictures

Background Esophageal stricture is a rare complication of radiotherapy: reports on its incidence and management are therefore anecdotal. Methods From January 1978 to September 1992, 44 patients presenting with an esophageal stricture related to a previous radiation treatment were endo-scopically dilated at the Endoscopy Division of the Istituto Nazionale Tumori of Milan. Results Esophageal recanalization was obtained in 95 % of the patients treated, and in 79 % of these normal eating habits were restored. No strict correlation was observed between radiation dose and severity of the stricture, or time elapsed between first treatment and endoscopic dilation. Conclusions In our experience, endoscopic dilation was a safe effective procedure and represented an effective palliative tool in dysphagic patients with esophageal strictures due to previous local radiotherapy.

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Does Dysphagia Indicate Recurrence of Benign Esophageal Strictures?

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.2.7 ◽

1995 ◽

Vol 2 (1) ◽

pp. 7-9

Author(s):

Olle Ekberg ◽

Anders Borgström ◽

Frans-Thomas Fork ◽

Eje Lövdahl

Keyword(s):

Esophageal Stricture ◽

Eating Habits ◽

Clinical History ◽

Barium Swallow ◽

Motor Disorder ◽

Esophageal Dysmotility ◽

Solid Bolus ◽

Retrosternal Pain ◽

Esophageal Strictures ◽

Dysphagic Patients

Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended.

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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.095 ◽

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.

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Management of esophageal strictures after endoscopic resection for early neoplasia

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820985298 ◽

2021 ◽

Vol 14 ◽

pp. 175628482098529

Author(s):

Einas Abou Ali ◽

Arthur Belle ◽

Rachel Hallit ◽

Benoit Terris ◽

Frédéric Beuvon ◽

...

Keyword(s):

Endoscopic Resection ◽

Endoscopic Treatment ◽

Esophageal Stricture ◽

Rare Event ◽

Median Number ◽

High Rate ◽

Endoscopic Dilatation ◽

Tertiary Referral Center ◽

Esophageal Neoplasia ◽

Esophageal Strictures

Background: Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia. Methods: We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures. Results: Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett’s neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0–4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2–7); range 1–17; p = 0.02], and in the case of circumferential resection [4.0 (3.0–7.0); p = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months. Conclusion: Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.

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Safety and outcome using endoscopic dilation for benign esophageal stricture without fluoroscopy

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.159236 ◽

2015 ◽

Vol 06 (02) ◽

pp. 055-058 ◽

Cited By ~ 2

Author(s):

E. R. Siddeshi ◽

M. V. Krishna ◽

Deepak Jaiswal ◽

M. Murali Krishna

Keyword(s):

Effective Treatment ◽

Success Rate ◽

Esophageal Stricture ◽

Guide Wire ◽

Endoscopic Dilation ◽

Benign Esophageal Stricture ◽

External Compression ◽

Esophageal Strictures ◽

Malignant Lesions

Abstract Aim: The aim was to investigate the use of Savary-Gilliard marked dilators in tight esophageal strictures without fluoroscopy. Materials and Methods: Four hundred and six patients with significant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions, and external compression were excluded. The procedure consisted of two parts. First, Savary-Gilliard or zebra guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, “the rule of three” was followed. Effective treatment was defined as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than 12 months. Results: One thousand and twenty-four dilatations sessions in a total of 408 patients were carried out. The success rate for placement of a guide wire was 100% and for dilatation 97% without the use of fluoroscopy, after 6 months–24 years of follow-up. The number of sessions per patient was between one and seven, with an average of three sessions. The ability of patients, after one or more sessions of dilatations to maintain a solid or semisolid diet for more than 12 months was obtained in 386 patients (95.8%). All patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted 22 failures. Conclusions: Dilatation (dilation) using Savary-Gilliard dilators without fluoroscopy are safe and effective in the treatment of very tight esophageal strictures if performed with care.

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Submucosal Esophageal Hematoma Following Sclerotherapy: A Rare Complication

Canadian Journal of Gastroenterology ◽

10.1155/1990/715941 ◽

1990 ◽

Vol 4 (1) ◽

pp. 23-25 ◽

Cited By ~ 1

Author(s):

Ram Singh ◽

YK Chawla ◽

Upjeet Kaur ◽

Neelam Malik ◽

JB Dilawari

Keyword(s):

Cirrhotic Patient ◽

Esophageal Stricture ◽

Rare Complication ◽

Intramural Hematoma ◽

Esophageal Variceal ◽

Esophageal Hematoma

A cirrhotic patient who developed an intramural hematoma of the esophagus as a complication of esophageal variceal sclerotherapy is reported. The hematoma resolved spontaneously within two weeks without any residual complications such as esophageal stricture.

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Impact of radiation dose and tumor size on large cell lymphoma patients in complete response after integrated CHOP-Bleo-radiation treatment protocol

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(94)00555-y ◽

1995 ◽

Vol 31 (1) ◽

pp. 193-194 ◽

Cited By ~ 1

Author(s):

John D. Earle

Keyword(s):

Radiation Dose ◽

Tumor Size ◽

Radiation Treatment ◽

Cell Lymphoma ◽

Treatment Protocol ◽

Large Cell ◽

Complete Response ◽

Large Cell Lymphoma

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“Peptic Esophageal Stricture In A Patient With Parkinson’s Disease”

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i06.01 ◽

2020 ◽

Vol 7 (06) ◽

pp. 4832-4836

Author(s):

M. Kovacheva Slavova ◽

Magdalena Aleksieva ◽

Victoria Ilieva ◽

Plamen Gecov ◽

Borislav Vladimirov

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Esophageal Stricture ◽

Distal Part ◽

Esophageal Resection ◽

Early Postoperative Period ◽

Antiparkinsonian Drug ◽

Successful Management ◽

Ivor Lewis ◽

Esophageal Strictures

Benign esophageal strictures are uncommon and their management remains challenging. Herein, we present a rare both functional and organic esophageal stricture in a patient with Parkinson’s disease and reflux esophagitis. The patient was diagnosed with severe complex stricture in the distal part of the esophagus, requiring surgical treatment. We performed subtotal esophageal resection and Ivor-Lewis gastroesophagoplasty. The successful management of antiparkinsonian drug therapy with adequate parenteral substitution in the early postoperative period is of great importance to avoid any further complications.

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