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Dysphagia

pp 1–11 | Cite as

Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies

  • Rakesh KochharEmail author
  • Sarthak Malik
  • Yalaka Rami Reddy
  • Usha Dutta
  • Narendra Dhaka
  • Saroj Kant Sinha
  • Bipadabhanjan Mallick
  • T. D. Yadav
  • Vikas Gupta
Original Article
  • 37 Downloads

Abstract

Background and Aims

This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).

Materials and Methods

Patients with anastomotic strictures (enrolled during January 1996–December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.

Results

Of the 142 patients, 124 (mean age—44.02; males—74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2–10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.

Conclusion

Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.

Keywords

Deglutition Deglutition disorders Endoscopic dilation Caustic anastomotic strictures Refractory stricture Recurrent stricture 

Abbreviations

CAS

Caustic anastomotic strictures

NCAS

Non-caustic anastomotic strictures (malignancy of head/neck/esophagus)

TTS

Through the scope

CRE

Controlled radial expansion

PDI

Periodic dilation index

SEMS

Self-expanding metal stents

THE

Trans-hiatal esophagectomy

Notes

Funding

The study was not supported by any funding or grants.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards and formal ethical clearance of the institutional ethics committee of Postgraduate Institute of Medical Education and Research, Chandigarh (20th April 2018 with registration number NK/4377/RES/172) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rakesh Kochhar
    • 1
    Email author
  • Sarthak Malik
    • 1
  • Yalaka Rami Reddy
    • 1
  • Usha Dutta
    • 1
  • Narendra Dhaka
    • 1
  • Saroj Kant Sinha
    • 1
  • Bipadabhanjan Mallick
    • 1
  • T. D. Yadav
    • 2
  • Vikas Gupta
    • 2
  1. 1.Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of SurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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