Abstract
Background
The outcomes of patients with refractory benign esophageal strictures (RBES) was unclear and lacking in relative researches on the clinical efficacy of dilation compared with stent placement. Our objective was to explore the role of endoscopic dilation and stents in the management of RBES.
Methods
This study including patients with RBES (recurrence of dysphagia despite endoscopic therapy more than 3 sessions) by dilation and stents between January 2009 and December 2017. Endoscopic therapy success was defined as: before the end of the follow-up, no need for endoscopic interventions for at least 6 months. The primary outcome was to assess clinical effectiveness and adverse events. Secondary outcome was to identify factors that predicted the dysphagia-free period (the time interval of two subsequent endoscopic interventions). Multivariate analysis was used to estimate the risk factors influencing the treatment success. To explore the trend of dysphagia-free period along with times used hierarchical linear models.
Results
75 patients (54 male; median age, 59 years) with RBES, 39 (52%), 20 (26.7%), 3 (4%), 10(13.3%), and 3(4%) were post-surgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median times of endoscopic therapy was 5 times (range 3, 21). Self-expandable metal stents (SEMSs) were placed in 20 patients (26.7%), and the success rate of patients treated with dilation (70.9%, 39/55) was higher than with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The dysphagia-free period of patients treated with dilation was 3.7months (95% CI, 2.7–5), and with stents was 2.3 months (95% CI, 1.5–3). The dysphagia-free period has linear growth trend with times, increased by 12 days per endoscopic therapy.
Conclusion
The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic dilation and stents tended to be effective in patients with RBES. Before the end of follow-up, nearly half of patients required continuing endoscopic dilation and stents, therefore, the patients with RBES may have negative long-term results. Stents therapy tended to not reduce the times and frequency of dilation.
Disclosure
All authors have declared no conflicts of interest.
Development and validation of a model to determine risk of refractory benign esophageal strictures