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. 2022 Dec;37(12):2272-2281.
doi: 10.1111/jgh.16005. Epub 2022 Oct 9.

Endoscopic radial incision versus endoscopic balloon dilation as initial treatments of benign esophageal anastomotic stricture

Zhao-Chao Zhang  1   2 , Jia-Qi Xu  1   2 , Jia-Xin Xu  1   2 , Mei-Dong Xu  1 , Shi-Yao Chen  1   2 , Yun-Shi Zhong  1   2 , Yi-Qun Zhang  1   2 , Wei-Feng Chen  1   2 , Li-Li Ma  1   2 , Wen-Zheng Qin  1   2 , Jian-Wei Hu  1   2 , Ming-Yan Cai  1   2 , Li-Qing Yao  1   2 , Quan-Lin Li  1   2 , Ping-Hong Zhou  1   2
Affiliations

Endoscopic radial incision versus endoscopic balloon dilation as initial treatments of benign esophageal anastomotic stricture

Zhao-Chao Zhang et al. J Gastroenterol Hepatol. 2022 Dec.

Abstract

Background and aim: We aim to evaluate the efficacy and safety of endoscopic radial incision (ERI) versus endoscopic balloon dilation (EBD) treatment of naïve, recurrent, and refractory benign esophageal anastomotic strictures.

Methods: One hundred and one ERI, 145 EBD, and 42 ERI combined with EBD sessions were performed in 136 consecutive patients with benign esophageal anastomotic stricture after esophagectomy at Zhongshan Hospital from January 2016 to August 2021. Baseline characteristics, operational procedures, and clinical outcomes data were retrospectively evaluated. Parameters and recurrence-free survival (RFS) were compared between ERI and EBD in patients with naïve or recurrent or refractory strictures. Risk factors for re-stricture after ERI were identified using univariate and multivariate analyses.

Results: Twenty-nine ERI versus 68 EBD sessions were performed for naïve stricture, 26 ERI versus 60 EBD for recurrent strictures, and 46 ERI versus 17 EBD for refractory stricture. With comparable baseline characteristics, RFS was greater in the ERI than the EBD group for naïve strictures (P = 0.0449). The ERI group had a lower 12-month re-stricture rate than the EBD group (37.9% vs 61.8%, P = 0.0309) and a more prolonged patency time (181.5 ± 263.1 vs 74.5 ± 82.0, P = 0.0233). Between the two interventions, recurrent and refractory strictures had similar RFS (P = 0.0598; P = 0.7668). Multivariate analysis revealed initial ERI treatment was an independent predictive factor for lower re-stricture risk after ERI intervention (odds ratio = 0.047, P = 0.001). Few adverse events were observed after ERI or EBD (3.0% vs 2.1%, P = 0.6918).

Conclusions: ERI is associated with lower re-stricture rates with better patency and RFS compared with EBD for naive strictures.

Keywords: benign esophageal anastomotic strictures; endoscopic balloon dilation; endoscopic radial incision.

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