Abstract
Background and study aims Radial incision and cutting (RIC) was established to improve refractory esophageal
anastomotic strictures but its efficacy and safety for nonsurgical refractory strictures
remain unclear. To evaluate the usefulness of RIC in nonsurgical refractory strictures,
we retrospectively compared outcomes between nonsurgical and surgical strictures.
Patients and methods We retrospectively studied 54 consecutive patients who were initially treated with
RIC for refractory benign esophageal stricture. The study variables included dysphasia
score improvement rate, frequency of repeated RIC, cumulative patency rate, cumulative
stricture improved rate, and adverse events(AEs), which were compared between nonsurgical
(n = 21) and surgical (n = 33) stricture groups.
Results Immediately after RIC, 90.5% of patients in the nonsurgical group and 84.8% of patients
in the surgical group had improvement in dysphagia (P = 0.69). The frequency of intervening repeated RIC was 42.9% in the nonsurgical group
and 42.4% in the surgical group (P = 0.98). During median follow-up of 22.3 months (range, 1.0–175.0), the cumulative
patency rate (P = 0.23) and cumulative stricture improvement rate (P = 0.14) but there was not statistical difference between the two groups. Despite
a low cumulative stricture improvement rate (9.5%) at 6 months after the first RIC
in the nonsurgical group, 57.7% of patients no longer required endoscopic balloon
dilatation at 2 years. The cumulative stricture improvement rate was significantly
lower in patients with a history of radiation therapy. No severe AEs were observed
in the nonsurgical group.
Conclusions RIC for nonsurgical refractory benign esophageal
stricture is an effective and safe treatment option.
Keywords
Endoscopy Upper GI Tract - Benign strictures - Dilation, injection, stenting - Endoscopic
resection (ESD, EMRc, ...)
