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22-04-2024 | Esophagus Resection | Review Article

Endoscopic incisional therapy for benign anastomotic strictures after esophagectomy or gastrectomy: a systematic review and meta-analysis

Authors: Zaharadeen Jimoh, Uzair Jogiat, Alex Hajjar, Kevin Verhoeff, Simon Turner, Clarence Wong, Janice Y. Kung, Eric L. R. Bédard

Published in: Surgical Endoscopy

Abstract

Background

Studies have evaluated the efficacy of endoscopic incisional therapy (EIT) for benign anastomotic strictures. We performed a systematic review and meta-analysis to evaluate stricture recurrence after EIT following esophagectomy or gastrectomy.

Methods

A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel–Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test.

Results

A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13–0.92, p = 0.03; I² = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17–0.59, p = 0.0003; I² = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12–3.28, p = 0.58; I² = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41–73.11, p = 0.006) among patients undergoing EIT compared to dilation.

Conclusion

Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures.

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Title: Endoscopic incisional therapy for benign anastomotic strictures after esophagectomy or gastrectomy: a systematic review and meta-analysis
Authors: Zaharadeen Jimoh
Uzair Jogiat
Alex Hajjar
Kevin Verhoeff
Simon Turner
Clarence Wong
Janice Y. Kung
Eric L. R. Bédard
Publication date: 22-04-2024
Publisher: Springer US
Keywords: Esophagus Resection
Esophagus Resection
Gastrectomy
Gastrectomy
Published in: Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10817-8

At a glance: The STEP trials

Springer Medicine

Endoscopic incisional therapy for benign anastomotic strictures after esophagectomy or gastrectomy: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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