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Endoscopic Stricturotomy in the Treatment of Refractory Esophageal Anastomotic Strictures

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Abstract

Refractory esophageal anastomotic strictures are a frequent challenge for endoscopists. The current therapeutic strategies have a significant restenosis rate, and patients usually require repeated sessions and suffer from dysphagia. Therefore, we propose a modified method named endoscopic stricturotomy (ES) to treat refractory esophageal anastomotic strictures. The patients diagnosed with refractory esophageal anastomotic strictures were enrolled in the cohort study. The method of ES is to incise longitudinally only a single strip of mucosa at the most prominent part of fibrotic scar and completely cut fibrotic tissues under the mucosa. The primary endpoint was the times of endoscopic therapies. The secondary endpoints include the effective rate, success rate, recurrence rate, endoscopic treatment intervals, complications, length of hospital stay, and surgical cost. The patients were followed up for at least 6 months after ES. The median anastomotic diameter of 12 patients was 2 mm (range 1 to 4 mm). Dysphagia were dramatically relieved in all patients (dysphagia grade from 3 to 1), the effective rate was 100%. During the follow-up, the 12 patients received a total number of 38 sessions, and the median number of ES sessions was 2.5 (1–9), and the success rate were 83%. Nine of the patients (75%) developed restenosis during follow-up, with a median interval of 38 days (15–315 days). No complications occurred during treatment and following up. The median hospital stay was 2 days (2–2.9 days), and the hospitalization costs was 3887.4 RMB (3632.8 RMB–4116.9 RMB). ES seems to be an effective treatment modality for refractory esophageal anastomotic strictures. Large prospective clinical trials are needed to confirm its utility and its place in the management of refractory esophageal anastomotic strictures (ChiCTR2000032997).

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Acknowledgements

No financial relationships with a commercial entity producing health-care related products and/or services relevant to this article. This work was supported by the Natural Science Foundation of China (No. 81500288), Pastdoctoral Scientific Research Developmental Fund of Heilongjiang Province (LBH-Q18080, LBH-Q19133), The Innovation of Foundation of the First Affiliated Hospital of Harbin Medical University (2019M08), Natural Science Foundation of Heilongjiang Province (LH2020H034), and The Outstanding Youth Foundation of the First Affiliated Hospital of Harbin Medical University (HYD2020JQ0005).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, No 246, Xuefu Road, NanGang District, Harbin, 150000, Heilongjiang, China

    Xiao Ma, Xu Zhang, Bing Li, Tingting Zhu, Tingting Ma & Bo Qu

  2. Department of Cardiology, First Affiliated Hospital of Harbin Medical University, No. 23, YouZheng Road, NanGang District, Harbin, 150001, Heilongjiang, China

    Xiaohui Zhang

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  1. Xiao Ma
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  2. Xu Zhang
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Correspondence to Xiaohui Zhang or Bo Qu.

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Ma, X., Zhang, X., Li, B. et al. Endoscopic Stricturotomy in the Treatment of Refractory Esophageal Anastomotic Strictures. Dysphagia 38, 650–656 (2023). https://doi.org/10.1007/s00455-022-10495-5

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  • DOI: https://doi.org/10.1007/s00455-022-10495-5

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