Efficacy and safety of repeated endoscopic radial incision and cutting procedure for benign esophageal stricture

Abstract

Background and study aims: Radial incision and cutting (RIC) is indicated for refractory benign esophageal strictures after curative treatment for esophageal cancer and has shown favorable short-term outcomes. However, re-stricture after RIC may occur in the long term, and RIC is performed repeatedly in such cases, but the efficacy and safety of repeated RIC are unclear. Therefore, we aimed to demonstrate the efficacy and safety of the repeated RIC for refractory benign esophageal strictures after surgical and non-surgical treatment.

Patients and methods: Between April 2008 and September 2019, we enrolled patients who were treated with the first RIC for benign esophageal strictures. The RIC was indicated for the refractory stricture and repeatedly performed for re-refractory esophageal stricture after RIC. We retrospectively evaluated the 6-month refractory stricture-free rate, and adverse events (AEs) in the first RIC and repeated RICs.

Results: Forty-six patients (39 men, 7 women; median age, 71 years, range 49–85) were included. RIC was performed once in 24 patients (non-repeated RIC group) and two or more times in 22 patients (repeated RIC group). In all patients, the 6-month refractory stricture-free rate after the first RIC were 42.3 %. In the repeated RIC group, the 6-month refractory stricture-free rate after the first and repeated RICs were 18.2 % vs 18.2 %, respectively. No AEs were noted.

Conclusions: Repeated RIC could be effective in the short-term and safe even for patients with refractory benign esophageal stricture after the first RIC. However, it cannot be considered curative treatment for refractory stricture because of poor long-term results.

• References

• 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
• 2 Honkoop P, Siersema PD, Tilanus HW. et al. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 1996; 111: 1141-1146 discussion 1147–1148
• 3 Newaishy GA, Read GA, Duncan W. et al. Results of radical radiotherapy of squamous cell carcinoma of the oesophagus. Clin Radiol 1982; 33: 347-352
• 4 Katada C, Muto M, Manabe T. et al. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 2003; 57: 165-169
• 5 Yoda Y, Yano T, Kaneko K. et al. Endoscopic balloon dilatation for benign fibrotic strictures after curative nonsurgical treatment for esophageal cancer. Surg Endosc 2012; 26: 2877-2883
• 6 Muto M, Ezoe Y, Yano T. et al. Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video). Gastrointest Endosc 2012; 75: 965-972
• 7 Lee TH, Lee SH, Park JY. et al. Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture. Gastrointest Endosc 2009; 69: 1029-1033
• 8 Hordijk ML, Siersema PD, Tilanus HW. et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc 2006; 63: 157-163
• 9 Simmons DT, Baron TH. Electroincision of refractory esophagogastric anastomotic strictures. Dis Esophagus 2006; 19: 410-414
• 10 Yano T, Yoda Y, Satake H. et al. Radial incision and cutting method for refractory stricture after nonsurgical treatment of esophageal cancer. Endoscopy 2013; 45: 316-319
• 11 Sami SS, Haboubi HN, Ang Y. et al. UK guidelines on oesophageal dilatation in clinical practice. Gut 2018; 67: 1000-1023
• 12 Spaander MCW, van der Bogt RD, Baron TH. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy 2021; 53: 751-762
• 13 Canena JM, Liberato MJ, Rio-Tinto RA. et al. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol 2012; 12: 70
• 14 van Boeckel PG, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol 2011; 9: 653-659
• 15 Yano T, Yoda Y, Nomura S. et al. Prospective trial of biodegradable stents for refractory benign esophageal strictures after curative treatment of esophageal cancer. Gastrointest Endosc 2017; 86: 492-499
• 16 Kataoka K, Aoyama I, Mizusawa J. et al. A randomized controlled Phase II/III study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Japanese J Clin Oncol 2015; 45: 385-389