Ye Zhu1,2, Sachin Mulmi Shrestha2, Ting Yu2, Ruihua Shi3,4. 1. College of Joint Training with Southeast University, Nanjing Medical University, Nanjing, China. 2. Department of Gastroenterology, Southeast University Zhongda Hospital, 87 Dingjiaqiao Road, Nanjing, Jiangsu Province, China. 3. College of Joint Training with Southeast University, Nanjing Medical University, Nanjing, China. ruihuashi@126.com. 4. Department of Gastroenterology, Southeast University Zhongda Hospital, 87 Dingjiaqiao Road, Nanjing, Jiangsu Province, China. ruihuashi@126.com.
Abstract
BACKGROUND: Refractory esophageal stricture is difficult to deal with. Some refractory stricture shows little response to now-existing endoscopic techniques. We assessed the efficacy of modified endoscopic radial incision and cutting method (M-RIC) for the treatment of refractory esophageal stricture. METHODS: This was a retrospective study. Patients with refractory esophageal stricture who underwent M-RIC or dilation from June 2016 to June 2020 were included. Outcomes measured included technical and clinical success, restenosis rate, time to restenosis and complications. Risk factors for restenosis after M-RIC were assessed. RESULTS: 67 patients were enrolled (M-RIC group, n = 29; dilation group, n = 38). After propensity score matching, each group include 28 patients. There were no significant differences in technical success (96.4% vs 100%, p = 1.00) or clinical success (89.3% vs 100%, p = 0.23) between groups. Patients in M-RIC group had lower rates of restenosis (75% vs. 100%, p = 0.02) and longer time to restenosis (110 days vs 31.5 days, p = 0.00) compared with dilation group. 4 patients did not require any additional treatment after M-RIC and maintained food intake until the end of follow-up. Complications of M-RIC include perforation, fever and retrosternal pain, and no difference was found in total complication rate when compared with dilation group (25% vs 7.1%, p = 0.07). Although 3 out of 28 patients (10.7%) in M-RIC group had perforation, the perforation rate was not significantly different between groups (p = 0.11). Multivariate analyze suggested stricture length ≥ 5 cm (HR 7.25, p = 0.00) was a risk factor to restenosis while oral prednisone (HR 0.29, p = 0.02) was associated with preventing restenosis after M-RIC. CONCLUSION: M-RIC is a feasible and effective technique for refractory esophageal stricture with lower rate and longer time to restenosis. Stricture length ≥ 5 cm is a risk factor to restenosis while oral prednisone is helpful in remitting restenosis after M-RIC.
BACKGROUND: Refractory esophageal stricture is difficult to deal with. Some refractory stricture shows little response to now-existing endoscopic techniques. We assessed the efficacy of modified endoscopic radial incision and cutting method (M-RIC) for the treatment of refractory esophageal stricture. METHODS: This was a retrospective study. Patients with refractory esophageal stricture who underwent M-RIC or dilation from June 2016 to June 2020 were included. Outcomes measured included technical and clinical success, restenosis rate, time to restenosis and complications. Risk factors for restenosis after M-RIC were assessed. RESULTS: 67 patients were enrolled (M-RIC group, n = 29; dilation group, n = 38). After propensity score matching, each group include 28 patients. There were no significant differences in technical success (96.4% vs 100%, p = 1.00) or clinical success (89.3% vs 100%, p = 0.23) between groups. Patients in M-RIC group had lower rates of restenosis (75% vs. 100%, p = 0.02) and longer time to restenosis (110 days vs 31.5 days, p = 0.00) compared with dilation group. 4 patients did not require any additional treatment after M-RIC and maintained food intake until the end of follow-up. Complications of M-RIC include perforation, fever and retrosternal pain, and no difference was found in total complication rate when compared with dilation group (25% vs 7.1%, p = 0.07). Although 3 out of 28 patients (10.7%) in M-RIC group had perforation, the perforation rate was not significantly different between groups (p = 0.11). Multivariate analyze suggested stricture length ≥ 5 cm (HR 7.25, p = 0.00) was a risk factor to restenosis while oral prednisone (HR 0.29, p = 0.02) was associated with preventing restenosis after M-RIC. CONCLUSION: M-RIC is a feasible and effective technique for refractory esophageal stricture with lower rate and longer time to restenosis. Stricture length ≥ 5 cm is a risk factor to restenosis while oral prednisone is helpful in remitting restenosis after M-RIC.
Authors: Alexander F Hagel; Andreas Naegel; Wolfgang Dauth; Klaus Matzel; Hermann P Kessler; Michael J Farnbacher; Werner M Hohenberger; Markus F Neurath; Martin Raithel Journal: J Gastrointestin Liver Dis Date: 2013-12 Impact factor: 2.008