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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(09): E1035-E1042
DOI: 10.1055/a-2382-6213
Original article

Efficacy and safety of radial incision and cutting for nonsurgical refractory benign esophageal stricture

Yosuke Mitani 
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Kenshiro Hirohashi
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Masashi Tamaoki
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Akira Yokoyama
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Chikatoshi Katada 
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Aya Ueda
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
,
Natsuko Yamahigashi
2   Medical Supply, Kyoto University Hospital, Kyoto, Japan (Ringgold ID: RIN34797)
,
Hirokazu Higuchi
2   Medical Supply, Kyoto University Hospital, Kyoto, Japan (Ringgold ID: RIN34797)
,
Manabu Muto
1   Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan (Ringgold ID: RIN38049)
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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, ...)


Publication History

Received: 10 May 2024

Accepted after revision: 07 August 2024

Accepted Manuscript online:
14 August 2024

Article published online:
10 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Mendelson AH, Small AJ, Agarwalla A. et al. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol 2015; 13: 263-271.e261
    CrossrefPubMedSearch in Google Scholar
  • 2 Agarwalla A, Small AJ, Mendelson AH. et al. Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures. Surg Endosc 2015; 29: 1903-1912
    CrossrefPubMedSearch in Google Scholar
  • 3 Ezoe Y, Muto M, Horimatsu T. et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 2011; 45: 222-227
    CrossrefPubMedSearch in Google Scholar
  • 4 Vermeulen BD, de Zwart M, Sijben J. et al. Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study. Gastrointest Endosc 2020; 91: 1058-1066
    CrossrefPubMedSearch in Google Scholar
  • 5 Sivasailam B, Lane BF, Cross RK. Endoscopic balloon dilation of strictures: techniques, short- and long-term outcomes, and complications. Gastrointest Endosc Clin N Am 2022; 32: 675-686
    CrossrefPubMedSearch in Google Scholar
  • 6 van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol 2015; 13: 47-58
    CrossrefPubMedSearch in Google Scholar
  • 7 Ikeya T, Ohwada S, Ogawa T. et al. Endoscopic balloon dilation for benign esophageal anastomotic stricture: factors influencing its effectiveness. Hepatogastroenterology 1999; 46: 959-966
    PubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Aoyama I, Takizawa K, Muto M. et al. Endoscopic balloon combined with steroid injection versus radial incision and cutting combineed with steroid injection for refractory anastomotic stricutre ater esophagectomy: A multicenter randomized controlled phase II/III study, JCOG1207. 31st United European Gastroenterology Week. 2023
    PubMedSearch in Google Scholar
  • 10 Amanuma Y, Horimatsu T, Ohashi S. et al. Association of local complete response with prognosis after salvage photodynamic therapy for esophageal squamous cell carcinoma. Dig Endosc 2021; 33: 355-363
    CrossrefPubMedSearch in Google Scholar
  • 11 Takenouchi N, Hoshino S, Hoshikawa Y. et al. Risk of hemorrhage and stricture significantly increases in elderly patients with proton pump inhibitor (PPI)-resistant reflux esophagitis. Esophagus 2020; 17: 87-91
    CrossrefPubMedSearch in Google Scholar
  • 12 Jinushi R, Ishii N, Yano T. et al. Endoscopic balloon dilation for the prevention of severe strictures caused by acute esophageal necrosis. DEN Open 2022; 2: e43
    CrossrefPubMedSearch in Google Scholar
  • 13 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Atkinson M, Ferguson R, Ogilvie AL. Management of malignant dysphagia by intubation at endoscopy. J R Soc Med 1979; 72: 894-897
    CrossrefPubMedSearch in Google Scholar
  • 15 Fugazza A, Repici A. Endoscopic management of refractory benign esophageal strictures. Dysphagia 2021; 36: 504-516
    CrossrefPubMedSearch in Google Scholar
  • 16 Abad MRA, Fujiyoshi Y, Inoue H. Flexible endoscopic strategies for the difficult esophageal stricture. Curr Opin Gastroenterol 2020; 36: 379-384
    CrossrefPubMedSearch in Google Scholar
  • 17 Debourdeau A, Barthet M, Benezech A. et al. Assessment of long-term results of repeated dilations and impact of a scheduled program of dilations for refractory esophageal strictures: a retrospective case-control study. Surg Endosc 2022; 36: 1098-1105
    CrossrefPubMedSearch in Google Scholar
  • 18 Zhu Y, Shrestha SM, Yu T. et al. Modified endoscopic radial incision and cutting method (M-RIC) for the treatment of refractory esophageal stricture. Surg Endosc 2022; 36: 1385-1393
    CrossrefPubMedSearch in Google Scholar
  • 19 Ravich WJ. Endoscopic management of benign esophageal strictures. Curr Gastroenterol Rep 2017; 19: 50
    CrossrefPubMedSearch in Google Scholar
  • 20 Kano Y, Kadota T, Inaba A. et al. Efficacy and safety of repeated endoscopic radial incision and cutting procedure for benign esophageal stricture. Endosc Int Open 2023; 11: E230-E236
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Novak JM, Collins JT, Donowitz M. et al. Effects of radiation on the human gastrointestinal tract. J Clin Gastroenterol 1979; 1: 9-39
    CrossrefPubMedSearch in Google Scholar
  • 22 Prisman E, Miles BA, Genden EM. Prevention and management of treatment-induced pharyngo-oesophageal stricture. Lancet Oncol 2013; 14: e380-386
    CrossrefPubMedSearch in Google Scholar