Endoscopic therapy through dilatation of benign esophageal stenosis
Abstract
Introduction: Endoscopic dilatation is the first therapeutic option to eliminate benign esophageal stenosis and improve the symptoms and the quality of life of those patients who suffer from it.
Objective: To describe the results of endoscopic dilatation in patients with benign esophageal stenosis treated in the National Center for Endoscopic Surgery from January 2015 to December 2016.
Material and Methods:A case series longitudinal observational study was conducted in 59 patients with benign esophageal stenosis. Dilatations were done with Savary-Gilliard bougie and balloons.
Results: The mean age was 52,5 years, and the condition predominated in 37 male patients (62,7%). Post-surgical, peptic, and caustic were the most frequent etiologies with 25, 14, and 6 cases, respectively. Short stenosis predominated in 51 cases. Bougies were used in 48 patients for a total of 149 dilatations, corresponding to a mean of 3,1 dilatations/ patients. Correction of the stenosis was made in 1-3 sessions in 47 % of patients; 11 cases were dilated with balloon, corresponding to a mean of 1- 3 dilatations/ patients. Four patients from the group that were dilated with Savary-Gilliard bougies showed refractoriness. A perforation, and two bleedings occurred. After the dilatations, dysphagia improved or disappeared in 93,2 % of patients.
Conclusions: Endoscopic therapy through dilatation of benign esophageal stenosis indicated to be a good alternative method in achieving corrections in a few dilatation sessions, with a low number of complications, and an improvement of the dysphagia.
Keywords: esophageal stenosis, benign esophageal stenosis, endoscopic therapy, balloon dilatation, dilatation with Savary-Gilliard bougies.
Downloads
References
REFERENCIAS BIBLIOGRÁFICAS
1. Siersema PD, de Wijkerslooth LR. Dilation of refractory benign esophageal strictures. Gastrointest Endos [Internet]. 2009 [citado 5 Jun 2016]; 70: 1000-12. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/19879408
2. Ravich WJ. Endoscopic management of benign esophageal strictures. Curr Gastroenterol Rep [Internet]. 2017 [citado 5 Sep 2017]; Aug 24; 19(10):50. Disponible en: https://link.springer.com/article/10.1007%2Fs11894-017-0591-8
3. Hwang JJ. Safe and proper management of esophageal stricture using endoscopic esophageal dilation. Clin Endosc [Internet]. 2017 [citado 5 Sep 2017]; 50(4): 309-10. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565041/
4. Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol [Internet]. 2017 [citado 12 May 2017]; Jan;11(1):53-64. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27835929, http://www.tandfonline.com/doi/abs/10.1080/17474124.2017.1260002?journalCode=ierh20
5. Wijkerslooth L.R.H, Vleggaar F.P, Siersema PD. Endoscopic management of difficult or recurrent esophageal strictures. Am J Gastroenterol [Internet]. 2011 [citado 18 Feb 2017]; 106:2080-91. Disponible en: https://www.nature.com/articles/ajg2011348
6. Van Boeckel P G, Siersema Peter D. Refractory esophageal strictures: What to do when dilation fails. Curr Treat Options in Gastroenterol [Internet]. 2015 [citado 18 Feb 2017]; 13:47–58. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4328110/pdf/11938_2014_Article_43.pdf
7. Hagel AF, Naegel A, Dauth W, Matzel K, Kessler HP, Farnbacher MJ, et al. Perforation during esophageal dilatation: a 10-year experience. J Gastrointestin Liver Dis [Internet]. 2013 [citado 18 Feb 2017]; 22(4): 385-89. Disponible en: http://www.jgld.ro/2013/4/5.html
8. Ruigomez A, García-Rodríguez LA, Wallander M, Johansson S, Eklund S. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol [Internet]. 2006 [citado 5 Jun 2016]; 101:2685–92. Disponible en: https://www.nature.com/articles/ajg2006506
9. Pereira-Lima JC, Ramires RP, Zamin I, Cassal AP, Marroni C.A, Mattos AA. Endoscopic dilation of benign esophageal strictures: Report on 1043 Procedures. Am J Gastroenterol [Internet]. 1999 [citado 4 Abr 2016]; 94 (6): 1497-1501. Disponible en: https://www.nature.com/articles/ajg1999357
10. Andreollo NA, Lopes LR, Inogutti R, Brandalise NA, Leonardi LS. Tratamento conservador das estenoses benignas do esófago através de dilatações. análise de 500 casos. Rev Ass Med Brasil [Internet]. 2001 [citado 4 Abr 2016]; 47(3): 236-43. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302001000300036
11. Novais P, Lemme E, Equi C, Medeiros C, Lopes C, Vargas C. Benign strictures of the esophagus: endoscopic approach with Savary-Gilliard bougies. Arq. Gastroenterol [Internet]. 2008 [citado 5 Feb 2016];45(4):290-94. Disponible en: http://www.academia.edu/6221411/Estenoses_benignas_de_es%C3%B4fago_abordagem_endosc%C3%B3pica_com_velas_de_Savary-Gilliard, https://www.researchgate.net/publication/23792246_Benign_strictures_of_the_esophagus_endoscopic_approach_with_Savary-Gilliard_bougies
12. Katz PO, Gerson LB, and Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol [Internet]. 2013 [citado 5 Jun 2016];108:308-28. Disponible en: https://www.nature.com/articles/ajg2012444, https://www.ncbi.nlm.nih.gov/pubmed/23419381
13. Piotet E, Escher A, Monnier P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol [Internet]. 2008 [citado 20 Jul 2016]; 265:357-64. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/17899143, https://link.springer.com/article/10.1007%2Fs00405-007-0456-0
14. Pasha SF, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc [Internet]. 2014 [citado 20 Jul 2016];79: 191-20. Disponible en: DOI: 10.1016/j.gie.2013.07.042, https://www.ncbi.nlm.nih.gov/pubmed/24332405
15. Fragoso Arbelo T, Sagaró González E, Trujillo Toledo ME, Lazo Diago O, Delgado Marrero B, de la Ronda Gallardo L, et al. Estenosis esofágicas benignas: tratamiento con las bujías de Savary-Gilliard. Rev Cuban Pediatr [Internet]. 2001 [citado 20 Jul 2016];73(3):173-80. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75312001000300004
16. Rodrigues-Pinto E, Pereira P, Ribeiro A, Lopes S, Moutinho-Ribeiro P, Silva M, et al. Risk factors associated with refractoriness to esophageal dilatation for benign dysphagia. Eur J Gastroenterol Hepatol [Internet]. 2016 [citado 20 Jul 2016]; 28 (6):684–688. Disponible en: https://insights.ovid.com/pubmed?pmid=26849463, DOI: 10.1097/MEG.0000000000000594
17. Choi CW, Kang DH, Kim HW, Park SB, Kim SJ, Nam HS, et al. Clinical outcomes of dilation therapy for anastomotic esophageal stricture. Korean J Gastroenterol [Internet]. 2017 [citado 5 Sep 2017]; Feb 25;69(2):102-108. Disponible en: DOI: 10.4166/kjg.2017.69.2.102, https://www.ncbi.nlm.nih.gov/pubmed/28239078
18. Pereira-Lima JC, Lemos Bonotto M, Hahn GD, Watte G, Lopes CV, dos Santos CE, et al. A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures: steroid injection after endoscopic dilation. Surg Endosc [Internet]. 2015 [citado 5 Sep 2017]; 29:1156–60. Disponible en: https://www.ncbi.nlm.nih.gov/m/pubmed/25171883/
19. Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: Technique and results. World J Gastrointest Endosc [Internet]. 2015 [citado 5 Jun 2016]; Dec 25;7(19):1318-26. Disponible en: DOI: 10.4253/wjge.v7.i19.1318, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689794/
20. Grooteman KV, Wong Kee Song LM, Vleggaar FP, Siersema PD, Baron TH. Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation. Gastrointest Endosc [Internet]. 2017 [citado 5 Sep 2017]; Feb;85(2):332-337. Disponible en: DOI: 10.1016/j.gie.2016.07.062, https://www.giejournal.org/article/S0016-5107(16)30548-X/pdf
21. Richter JE. Rule of three for esophageal dilation: like the tortoise versus the rabbit, low and slow is our friend and our patients' win. Gastrointest Endosc [Internet]. 2017 [citado 5 Sep 2017]; 85(2):338–9. Disponible en: https://www.giejournal.org/article/S0016-5107(16)30548-X/fulltext
22. van Halsema EE, Noordzij IC, van Berge Henegouwen MI, Fockens P, Bergman JJ, van Hooft JE. Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect. Surg Endosc [Internet]. 2017 [citado 5 Sep 2017];31:1871. Disponible en: https://link.springer.com/article/10.1007/s00464-016-5187-0
23. Zhou WZ, Song HY, Park JH, Cho YC, Jun EJ, Park J, et al. Full-thickness esophageal perforation after fluoroscopic balloon dilation: incidence and management in 820 adult patients. AJR Am J Roentgenol [Internet]. 2015 [citado 5 Jun 2016];204(5):1115-9. Disponible en: https://www.ajronline.org/doi/full/10.2214/AJR.14.13614
24. Olson JS, Lieberman DA, Sonnenberg A. Practice patterns in the management of patients with esophageal strictures and rings. Gastrointest Endosc [Internet]. 2007 [citado 12 May 2016]; 66(4): 670-675. Disponible en: http://www.giejournal.org/article/S0016-5107(07)00326-4/fulltext
25. Mönkemüller K, Kalauzc M, Fry LC, editors. Endoscopic dilation of benign and malignant esophageal strictures. In: Mönkemüller K, Wilcox CM, Munoz-Navas M, editors. Interventional and therapeutic gastrointestinal endoscopy. Basel: Karger; 2010. p. 91-105. (Lerch MM, vol. editor. Frontiers of Gastrointestinal Researgh; vol. 27).