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. 2018 Nov;25(6):291-298.
doi: 10.1159/000486608. Epub 2018 Feb 8.

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

Diana Martins  1 , Sara Pires  2 , Pedro Pimentel-Nunes  3   4   5 , Rui Almeida Silva  3 , Claúdia Camila Dias  4   6 , Mário Dinis-Ribeiro  3   4   5
Affiliations

Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter

Diana Martins et al. GE Port J Gastroenterol. 2018 Nov.

Abstract
in English, Portuguese

Background/aims: Dysphagia due to benign pharyngoesophageal strictures (PES) often requires repeated dilations; however, a uniform definition for the therapeutic efficacy of this technique has not been yet established. We aimed to assess the overall efficacy of endoscopic dilation of pharyngoesophageal anastomotic or post-radiotherapy (post-RT) strictures.

Methods: The data of 48 patients with post-RT (n = 29) or anastomotic PES (n = 19) submitted to endoscopic dilation during a 3-year period were retrospectively assessed. The Kochman criteria were used to determine refractoriness and recurrence. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as (a) dysphagia improvement, (b) dysphagia resolution, (c) need for further dilations, or (d) percutaneous endoscopic gastrostomy (PEG) during the previous 6 months. Need for additional therapy was considered an inefficacy criterion.

Results: The median number of dilations per patient was 4 (total of 296 dilations) with a median follow-up of 29 months. The mean predilation dysphagia Mellow-Pinkas score was 3 and the initial stenosis diameter was 7 mm. Fifteen and 29% of patients presented with the Kochman criteria for refractory and recurrent strictures, respectively. Moreover, 96 and 60% showed dysphagia improvement and resolution, respectively. Seventy-five-percent did not require dilations during 6 months, and 89% did not require PEG. From the patients' perspective, overall efficacy was achieved in 58% of cases. Nine additional therapies were required. Number of dilations (OR 0.7), stricture diameter (OR 2.2), and nonrecurrence criteria (OR 14.2) appeared as significant predictors of overall efficacy, whereas refractory stenosis criteria did not.

Conclusions: Endoscopic dilation seems to be effective for patients with dysphagia after RT or surgery, especially when assessed as patient perception of improvement. Narrow strictures, recurrent ones, and strictures requiring a higher number of dilations may predict worse outcomes.

Key message: Health professionals should establish well-defined efficacy criteria for dilations and base their decision beyond exclusively objective measurements.

Introdução e objetivo: A disfagia devido a estenoses farin-go-esofágicas benignas requer frequentemente dilatações repetidas, não existindo, contudo, uma definição estabe-lecida para a eficácia desta terapêutica. Pretendemos ava-liar a eficácia-global de dilatações endoscópicas de esteno-ses rádicas e anastomóticas faringo-esofágicas.

Métodos: 48 doentes com estenoses pós-radioterapia (n = 29) e este-noses anastomóticas (n = 19) submetidos a dilatação en-doscópica durante um período de 3 anos foram avaliados retrospetivamente. Os critérios de Kochman foram utilizados para determinar refratariedade e recorrência. Os doen-tes foram convidados a responder um questionário deter-minando prospectivamente a eficácia-global das dilata-ções como (a) melhoria da disfagia ou (b) resolução, (c) ausência de dilatação adicional durante 6 meses e (d) au-sência de PEG para alimentação. A necessidade de tera-pêutica adicional foi considerada um critério de ineficácia.

Resultados: A mediana do número de dilatações por doente foi de 4 (total de 296 dilatações) durante um followup médio de 29 meses. O grau de disfagia (Mellow-Pinkas score) médio pré-dilatação foi 3 e o diâmetro inicial médio da estenose foi 7 mm. Quinze e 29% apresentaram critérios para estenoses refratárias e recorrentes, respetivamente. Ademais, (a) 96% dos pacientes apresentaram melhoria da disfagia, (b) 60% resolução, (c) 75% não exigiram dilatação durante 6 meses e (d) 89% não necessitaram de PEG. Em suma, 58% apresentaram critérios de eficácia-global. Fo-ram necessárias nove terapêuticas adicionais. O número de dilatações (OR 0.7), o diâmetro da estenose (OR 2.2) e a au-sência de critérios de recorrência (OR 14.2) apareceram como preditores significativos de eficácia global, mas as estenoses refratárias não.

Conclusões: A dilatação en-doscópica parece eficaz para estenoses pós-radioterapia ou cirurgia, especialmente quando avaliada subjetiva-mente. Estenoses estreitas, recorrentes e que requerem maior número de dilatações parecem prever piores outcomes.

Mensagem-chave: Os profissionais de saúde de-vem estabelecer critérios de eficácia bem definidos para as dilatações, não devendo basear a sua decisão apenas em medidas objetivas.

Keywords: Benign esophageal strictures; Dilation; Endoscopy; Personal satisfaction; Treatment outcome.

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Figures

Fig. 1
Fig. 1
Efficacy-defining criteria and overall efficacy of the endoscopic dilation program (expressed in %). * Twenty-one of 36 patients (28 interview responders plus 8 presenting inefficacy criteria due to additional therapy) presented overall efficacy criteria.
See this image and copyright information in PMC

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