What Should Be Done if Dilatations with Adjuncts Fail?
Conservative management is still preferable to esophageal replacement after failure of dilatation with adjuncts. There is no consensus about the definition of a refractory stricture or recurrent stricture. Before classifying a stricture as “refractory” it is important to assure that it was properly treated. Endoscopic electrocautery incisional therapy (EIT) and esophageal stenting may be successful. Removable covered stents allowed its use in children and expanded the indications for its usage to include a wide variety of congenital and acquired esophageal strictures. Contrary to other stents where food passes within the stent, the food in the customized dynamic stent passes between the stent and the esophageal wall allowing long term improvement of esophageal patency. The dynamic stents improve esophageal motility unlike the widespread self-expandable plastic or metallic esophageal stents. Stents are very effective for treating post-dilatation perforations and post-anastomotic leaks. Gagging, stent displacement, migration into the stomach, perforation, air way compression, granulation tissue, GERD, aspiration pneumonia, and arterioesophageal fistula are possible complications of stents.
KeywordsBenign esophageal stricture Refractory stricture Recurrent stricture Esophageal stents
- 3.Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V, et al. Anastomotic stricture after esophageal atresia repair: incidence, investigation, and management including treatment of refractory and recurrent stricture. Front Pediatr. 2017;5:120. https://doi.org/10.3389/ped2017.00120.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Dall’Oglio L, Caldaro T, Foschia F, Faraci S, Federrici di Abriola G, Rea F, et al. Endoscopic management of esophageal stenosis in children: new and traditional treatments. World J Gastrointest Endosc. 2016;8(4):212–9. https://doi.org/10.4253/wjge.v8.i4.212.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Spaander MC, Maron TH, Fuccio L, Schumacher Escorsell A, Escorsell A, Juan-Carlos Garcia-Pagán JC, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016;48:939–48. https://doi.org/10.1055/s-0042-114210.CrossRefPubMedGoogle Scholar
- 11.Walter D, Van den Berg MW, Hirdes MM. A randomized trial comparing biodegradable stent placement and endoscopic dilatation for recurrent benign esophageal strictures (Destiny study). United Eur Gastroenterol J. 2015;3(5 Suppl):A24.Google Scholar
- 14.Manfredi MA, Jennings RW, Anjum MW, Hamilton TE, Smithers CJ, Lightdale JR. Externally removable stents in the treatment of benign recalcitrant strictures and esophageal perforations in pediatric patients with esophageal atresia. Gastrointest Endosc. 2014;80:246–52. https://doi.org/10.1016/j.gie.2014.01.033.CrossRefPubMedGoogle Scholar
- 22.Dellon ES, Cullen NR, Madanick RD, Buckmire RA, Grimm IS, Weissler MC, et al. Outcomes of a combined antegrade and retrograde approach for dilatation of radiation-induced esophageal strictures (with video). Gastrointest Endosc. 2010;71(7):1122–9. https://doi.org/10.1016/j.gie.2009.12.057.CrossRefPubMedGoogle Scholar