Original article
Clinical endoscopy
Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video)

https://doi.org/10.1016/j.gie.2012.01.012Get rights and content

Background

There is no effective treatment for gastroesophageal anastomotic strictures that are refractory to repeated endoscopic balloon dilation (EBD). However, EBD is still selected worldwide to manage such refractory strictures. To relieve the symptoms of dysphagia and keep a wide lumen, we developed a new incisional treatment, radial incision and cutting (RIC).

Objective

To evaluate the efficacy and safety of the RIC method for the treatment of refractory anastomotic strictures.

Setting

National Cancer Center and University Hospital.

Patients

This study involved 54 consecutive patients with refractory anastomotic stricture after esophagogastric surgery.

Intervention

RIC.

Main Outcome Measurements

The safety and clinical success of RIC and the long-term patency after RIC compared with those of continued EBD.

Results

The median procedure time of RIC was 14 minutes (range, 4–40 minutes). No serious adverse events associated with RIC were observed. Immediately after RIC, 81.3% (26/32) of patients were able to eat solid food without symptoms of dysphagia. As a short-term effect, the dysphagia improved after RIC in 93.8% (30/32) of the patients. As a long-term effect, 63% (17/27) and 62% (13/21) of patients were able to eat solid food 6 and 12 months after RIC, respectively. The 6-month and 12-month patency rates were significantly different between the RIC group and the continued EBD group (65.3% vs 19.8%, P < .005; 61.5% vs 19.8%, P < .005).

Limitations

Nonrandomized retrospective study.

Conclusions

RIC is an effective and safe method. The demonstration of the validity of this method may place RIC as a new medical treatment for patients with refractory stricture after surgical resection for esophagogastric diseases.

Section snippets

Patients

From May 2006 to March 2011, 32 consecutive patients with refractory anastomotic stricture after esophagogastric surgery were treated with RIC and were followed up at the National Cancer Center Hospital East and the Kyoto University Hospital. Refractory esophagogastric stricture was considered when the stricture could not be improved to a diameter larger than 10 mm and 3 or more sessions of EBD (CRE balloon dilator, Boston Scientific, Natick, MA) with at least 1 week of interval had been

Patient characteristics

Patient characteristics are summarized in Table 1. In the RIC group, the median age was 66 years (range, 33-81 years), and the male-to-female ratio was 26:6. The strictures were caused by esophagectomy in 30 patients (93.8%), and the remaining 2 strictures (6.2%) were caused by proximal gastrectomy. The median number of EBD sessions per patient before RIC was 10 (range, 3-56 sessions) and the median latency of strictures requiring EBD before RIC was 5.8 months (range, 1.3-172 months). Before

Discussion

Most esophagogastric anastomotic strictures can be managed successfully with EBD or rigid dilation. However, refractory strictures that do not respond to repeated dilation are difficult to manage. In addition, refractory anastomotic strictures impair severely the patients' quality of life and adequate food intake.

This study shows that the application of the RIC method by using an IT knife for the treatment of refractory anastomotic strictures was effective and safe. The demonstration of the

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

See CME section; p. 1068.

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