Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture - 23/08/11
Reprint requests: Suck-Ho Lee, MD, Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan, Choongnam, Republic of Korea.Cheonan, Choongnam, Korea
Abstract |
Background |
Benign anastomotic esophageal stricture after surgical resection is not uncommon and requires repeated dilation sessions to maintain patency because of the significant recurrence rate with bougie or balloon dilation.
Objective |
Our study was designed to evaluate whether a modified method of incisional therapy is effective and maintains a good patency in a benign anastomotic esophageal stricture.
Design |
A prospective outcome study.
Setting |
Tertiary-care academic medical centers.
Patients |
A total of 24 patients with benign anastomotic esophageal strictures after esophagojejunostomy.
Interventions |
Under direct vision through a transparent hood, radial incisions parallel to the longitude of the esophagus were performed by pulling up the Iso-Tome or insulated-tip–knife.
Main Outcome Measurements |
Efficacy, safety, and long-term patency after procedures were evaluated.
Results |
During 24 months of follow-up observations, 21 of 24 patients (87.5%) who received only 1 dilation session resumed eating solid meals and had no dysphagia. Only 3 patients (12.5%) developed restricture at a mean of 1.6 months. Of the patients with a recurrence, 2 experienced no recurrence after one additional dilation session, and another patient was refractory and underwent 5 dilation sessions. The occurrence of restricture after incisional therapy was statistically more prevalent in long-segment stricture (>1 cm) (2/3 [66.7%]) than short-segment stricture (<1 cm) (1/21 [4.8%]) (P = .032). There were no significant procedure-related complications.
Limitation |
Our study included a small number of patients. Therefore, further prospective randomized controlled trials are needed.
Conclusions |
A modified method of incisional therapy as a primary treatment is safe and feasible, and appears to maintain a longer duration of patency in benign anastomotic esophageal stricture.
Il testo completo di questo articolo è disponibile in PDF.Abbreviation : IT-knife
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| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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Vol 69 - N° 6
P. 1029-1033 - maggio 2009 Ritorno al numero
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