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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 5/2022

25-02-2022 | Dysphagia | Review

Endoscopic Management of Luminal Strictures: Beyond Dilation

Authors: Nader D. Daoud, Hassan Ghoz, Obaie Mzaik, Himesh B. Zaver, Micah McKinney, Bhaumik Brahmbhatt, Timothy Woodward

Published in: Digestive Diseases and Sciences | Issue 5/2022

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Abstract

Luminal strictures can occur as part of many different gastrointestinal (GI) disorders anywhere along the GI tract and affect all age groups. The end goal of managing any stricture is to re-establish an adequate and durable luminal patency that is sufficient to resolve the presenting clinical symptoms. Treatment options can be generally categorized into medical, endoscopic, and surgical. However, within each of these categories, multiple different options are available. Therefore, choosing the best treatment modality is often challenging and depends on multiple factors including the type, location, and complexity of the stricture, as well as the preference of the treating physician. In this article, we will review the most current literature regarding foregut strictures, particularly esophageal and gastric, beyond dilation.
Literature
1.
Desai, J.P. and F. Moustarah, Esophageal Stricture, in StatPearls. 2020: Treasure Island (FL).
2.
Dykes DM et al. Increased prevalence of luminal narrowing and stricturing identified by enterography in pediatric Crohn’s disease patients with elevated granulocyte-macrophage colony stimulating factor autoantibodies. Inflamm Bowel Dis 2013;19:2146–2154.PubMedCrossRef
3.
4.
5.
Shami VM. Endoscopic management of esophageal strictures. Gastroenterol Hepatol 2014;10:389–391.
6.
Richter JE, Rubenstein JH. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology 2018;154:267–276.PubMedCrossRef
7.
Pasha SF et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc 2014;79:191–201.PubMedCrossRef
8.
Taitelbaum G, Petersen BT, Barkun AN, Chotiprasidhi P, Chuttani R, Liu J, Ginsberg GG. Tools for endoscopic stricture dilation: November 2003. Gastrointest Endosc 2004;59:753–760.CrossRef
9.
Siersema PD. How to approach a patient with refractory or recurrent benign esophageal stricture. Gastroenterology 2019;156:7–10.PubMedCrossRef
10.
Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol 2017;11:53–64.PubMedCrossRef
11.
Manfredi MA. Endoscopic management of anastomotic esophageal strictures secondary to esophageal atresia. Gastrointest Endosc Clin N Am 2016;26:201–219.PubMedCrossRef
12.
Szapary L et al. Intralesional steroid is beneficial in benign refractory esophageal strictures: a meta-analysis. World J Gastroenterol 2018;24:2311–2319.PubMedPubMedCentralCrossRef
13.
Henskens N, Wauters L, Vanuytsel T. Intralesional steroid injections in addition to endoscopic dilation in benign refractory esophageal strictures: a systematic review. Acta Gastro-enterol Belg 2020;83:432–440.
14.
Hanaoka N et al. Endoscopic balloon dilation followed by intralesional steroid injection for anastomotic strictures after esophagectomy: a randomized controlled trial. Am J Gastroenterol 2018;113:1468–1474.PubMedCrossRef
15.
Divarci E et al. The efficacy of intralesional steroid injection in the treatment of corrosive esophageal strictures in children. Surg Laparosc Endosc Percutan Techn 2016;26:e122–e125.CrossRef
16.
Pih GY et al. Preventing esophageal strictures with steroids after endoscopic submucosal dissection in superficial esophageal neoplasm. J Dig Dis 2019;20:609–616.PubMedCrossRef
17.
18.
Ishihara R et al. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 2020;32:452–493.PubMedCrossRef
19.
Nagami Y et al. Prediction of esophageal stricture in patients given locoregional triamcinolone injections immediately after endoscopic submucosal dissection. Dig Endosc 2018;30:198–205.PubMedCrossRef
20.
El-Asmar KM et al. Topical mitomycin C application is effective in management of localized caustic esophageal stricture: a double-blinded, randomized, placebo-controlled trial. J Pediatr Surg 2013;48:1621–1627.PubMedCrossRef
21.
Bartel MJ et al. Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review. Digest Liver Dis 2016;48:1058–1065.CrossRef
22.
Rashed YK, El-Guindi M. Endoscopic postdilatation application of Mitomycin C in children with resistant esophageal strictures. Korean J Pediatr 2019;62:395–399.PubMedPubMedCentralCrossRef
23.
Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg 2012;22:109–16.PubMedCrossRef
24.
Machida H et al. Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection. Endoscopy 2012;44:622–625.PubMedCrossRef
25.
Nissenkorn I, Herrod H, Soloway MS. Side effects associated with intravesical mitomycin. J Urol 1981;126:596–597.PubMedCrossRef
26.
Reijm AN et al. Self-expandable metal stent placement for malignant esophageal strictures—Changes in clinical outcomes over time. Endoscopy 2019;51:18–29.PubMedCrossRef
27.
Kang Y. A review of self-expanding esophageal stents for the palliation therapy of inoperable esophageal malignancies. Biomed Res Int 2019;2019:9265017.PubMedPubMedCentralCrossRef
28.
Didden P et al. Fully vs. partially covered selfexpandable metal stent for palliation of malignant esophageal strictures: a randomized trial (the COPAC study). Endoscopy 2018;50:961–971.PubMedCrossRef
29.
Hindy P et al. A comprehensive review of esophageal stents. Gastroenterol Hepatol (N Y) 2012;8:526–534.
30.
31.
Hindy P et al. A comprehensive review of esophageal stents. Gastroenterol Hepatol 2012;8:526–534.
32.
33.
Liu J et al. Removable, fully covered, self-expandable metal stents for the treatment of refractory benign esophagogastric anastomotic strictures. Dysphagia 2012;27:260–264.PubMedCrossRef
34.
Rieder E et al. Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilatation for achalasia treatment. Dis Esophagus 2017;30:1–6.PubMedCrossRef
35.
Law R et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc 2018;32:675–681.PubMedCrossRef
36.
Zimmer V. Gastrointestinal: Utilization of a novel dedicated stent fixation clip device (“stentfix OTSC”) for an umbrella-type cardia stent. J Gastroenterol Hepatol 2020;35:1466.PubMedCrossRef
37.
Burstow M et al. Outcome of palliative esophageal stenting for malignant dysphagia: a retrospective analysis. Dis Esophagus 2009;22:519–525.PubMedCrossRef
38.
Wang MQ et al. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J Vasc Intervent Radiol 2001;12:465–474.CrossRef
39.
Reijm AN et al. Early pain detection and management after esophageal metal stent placement in incurable cancer patients: a prospective observational cohort study. Endosc Int Open 2016;4:E890–E894.PubMedPubMedCentralCrossRef
40.
Coron E et al. Antireflux versus conventional self-expanding metallic Stents (SEMS) for distal esophageal cancer: results of a multicenter randomized trial. Endosc Int Open 2016;4:E730–E736.PubMedPubMedCentralCrossRef
41.
van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treatment Opt Gastroenterol 2015;13:47–58.CrossRef
42.
Repici A et al. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Therap 2010;31:1268–1275.CrossRef
43.
Holm AN et al. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc 2008;67:20–25.PubMedCrossRef
44.
Dua KS et al. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol 2008;103:2988–2994.PubMedCrossRef
45.
46.
47.
Griffiths EA et al. The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease. Surg Endosc 2012;26:2367–2375.PubMedCrossRef
48.
Saito Y et al. Usefulness of biodegradable stents constructed of poly-l-lactic acid monofilaments in patients with benign esophageal stenosis. World J Gastroenterol 2007;13:3977–3980.PubMedPubMedCentralCrossRef
49.
Hallac A et al. Economical effect of lumen apposing metal stents for treating benign foregut strictures. World J Gastrointest Endosc 2018;10:294–300.PubMedPubMedCentralCrossRef
50.
Adler DG. Lumen-apposing metal stents for the treatment of refractory benign esophageal strictures. Am J Gastroenterol 2017;112:516–517.PubMedCrossRef
51.
52.
Hordijk ML et al. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc 2009;70:849–855.PubMedCrossRef
53.
Wills JC et al. A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki’s) rings. Gastrointest Endosc 2008;67:808–813.PubMedCrossRef
54.
Hordijk ML et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc 2006;63:157–163.PubMedCrossRef
55.
Beilstein MC, Kochman ML. Endoscopic incision of a refractory esophageal stricture: novel management with an endoscopic scissors. Gastrointest Endosc 2005;61:623–625.PubMedCrossRef
56.
Muto M et al. Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video). Gastrointest Endosc 2012;75:965–972.PubMedCrossRef
57.
Lee TH et al. Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture. Gastrointest Endosc 2009;69:1029–1033.PubMedCrossRef
58.
Manfredi MA et al. Endoscopic electrocautery incisional therapy as a treatment for refractory benign pediatric esophageal strictures. J Pediatr Gastroenterol Nutr 2018;67:464–468.PubMedCrossRef
59.
Canhoto M et al. Needle-knife incisional treatment of refractory esophagic caustic stenosis. Endoscopy 2011;43:E386.PubMedCrossRef
60.
Pang M et al. Selective application of fully covered biliary stents and narrow-diameter esophageal stents for proximal esophageal indications. Endoscopy 2019;51:169–173.PubMedCrossRef
61.
Bechtler M et al. Biliary metal stents for proximal esophageal or hypopharyngeal strictures. Surg Endosc 2015;29:3205–3208.PubMedCrossRef
62.
Bueno R et al. Combined antegrade and retrograde dilation: a new endoscopic technique in the management of complex esophageal obstruction. Gastrointest Endosc 2001;54:368–372.PubMedCrossRef
63.
Perbtani Y, Suarez AL, Wagh MS. Emerging techniques and efficacy of endoscopic esophageal reconstruction and lumen restoration for complete esophageal obstruction. Endosc Int Open 2016;4:E136–E142.PubMedPubMedCentralCrossRef
64.
Al-Haddad M et al. Antegrade and retrograde endoscopic approach in the establishment of a neo-esophagus: a novel technique. Gastrointest Endosc 2007;65:290–294.PubMedCrossRef
65.
Tringali A, Giannetti A, Adler DG. Endoscopic management of gastric outlet obstruction disease. Ann Gastroenterol 2019;32:330–337.PubMedPubMedCentral
66.
Appasani S et al. Benign gastric outlet obstruction–spectrum and management. Trop Gastroenterol 2011;32:259–266.PubMed
67.
Basile P, Marre C, Le Mouel JP. Gastric obstruction secondary to an unexplained hyperinflation of an intragastric balloon. Clin Gastroenterol Hepatol 2020;18:A16.PubMedCrossRef
68.
DiSario JA et al. Endoscopic balloon dilation for ulcer-induced gastric outlet obstruction. Am J Gastroenterol 1994;89:868–871.PubMed
69.
Zargar SA et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol 1992;87:337–341.PubMed
70.
71.
Hindryckx P, Degroote H. Lumen-apposing metal stents for approved and off-label indications: a single-centre experience. Surg Endosc 2021;35:6013–6020.PubMedCrossRef
72.
Khashab MA et al. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 2017;5:E275–E281.PubMedPubMedCentralCrossRef
73.
Chandan S et al. EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis. Endosc Int Open 2021;9:E496–E504.PubMedPubMedCentralCrossRef
74.
McCarty TR et al. Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: a systematic review and meta-analysis. Endosc Int Open 2019;7:E1474–E1482.PubMedPubMedCentralCrossRef
75.
Tyberg A et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016;4:E276–E281.PubMedPubMedCentralCrossRef
76.
Ge PS et al. EUS-guided gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction. Surg Endosc 2019;33:3404–3411.PubMedPubMedCentralCrossRef
77.
Ghoz H, Foulks C, Gomez V. Management of afferent limb obstruction by use of EUS-guided creation of a jejunojejunostomy and placement of a lumen-apposing metal stent. VideoGIE 2019;4:337–340.PubMedPubMedCentralCrossRef
78.
79.
Lau JY et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996;43:98–101.PubMedCrossRef
80.
Heo J, Jung MK. Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction. World J Gastroenterol 2014;20:16721–16725.PubMedPubMedCentralCrossRef
81.
82.
Kim CG et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc 2010;72:25–32.PubMedCrossRef
83.
84.
85.
East JE et al. A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of Crohn’s strictures. Clin Gastroenterol Hepatol 2007;5:1065–1069.PubMedCrossRef
86.
Hendel J, Karstensen JG, Vilmann P. Serial intralesional injections of infliximab in small bowel Crohn’s strictures are feasible and might lower inflammation. United European Gastroenterol J 2014;2:406–412.PubMedPubMedCentralCrossRef
87.
88.
Karstensen JG et al. Biodegradable stents for the treatment of bowel strictures in Crohn’s disease: technical results and challenges. Endosc Int Open 2016;4:E296-300.PubMedPubMedCentralCrossRef
89.
90.
Adler DG. Colonic strictures: dilation and stents. Gastrointest Endosc Clin N Am 2015;25:359–371.PubMedCrossRef
91.
Vanbiervliet G et al. Fully covered self-expanding metal stents for benign colonic strictures. Endoscopy 2013;45:35–41.PubMed
92.
Perez Roldan F et al. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas. Endoscopy 2012;44:297–300.PubMedCrossRef
93.
Jain D, Sandhu N, Singhal S. Endoscopic electrocautery incision therapy for benign lower gastrointestinal tract anastomotic strictures. Ann Gastroenterol 2017;30:473–485.PubMedPubMedCentral
94.
Jimenez-Perez J et al. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 2011;106:2174–2180.PubMedCrossRef
95.
Ribeiro IB et al. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open 2018;6:E558–E567.PubMedPubMedCentralCrossRef
96.
Weston BR et al. Efficacy of uncovered colonic stents for extrinsic versus intrinsic malignant large bowel obstruction. Surg Endosc 2021;35:4511–4519.PubMedCrossRef
97.
98.
Sudan R et al. Sleeve gastrectomy strictures: technique for robotic-assisted strictureplasty. Surg Obes Relat Dis 2010;6:434–436.PubMedCrossRef
99.
Divarci E et al. The efficacy of intralesional steroid injection in the treatment of corrosive esophageal strictures in children. Surg Laparosc Endosc Percutan Tech 2016;26:e122–e125.PubMedCrossRef
100.
Henskens N, Wauters L, Vanuytsel T. Intralesional steroid injections in addition to endoscopic dilation in benign refractory esophageal strictures: a systematic review. Acta Gastroenterol Belg 2020;83:432–440.PubMed
101.
Randhawa FA et al. Effectiveness of intralesional steroid injections with dilatation in corrosive oesophageal strictures—a randomized control trial. J Pak Med Assoc 2018;68:1556–1559.PubMed
102.
Bartel MJ et al. Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review. Dig Liver Dis 2016;48:1058–1065.PubMedCrossRef
103.
Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg 2012;22:109–116.PubMedCrossRef
104.
Nagaich N et al. Mitomycin-C: “a ray of hope” in refractory corrosive esophageal strictures. Dis Esophagus 2014;27:203–205.PubMedCrossRef
105.
Sweed AS et al. A prospective controlled study to assess the use of mitomycin C in improving the results of esophageal dilatation in post corrosive esophageal stricture in children. Int J Pediatr Otorhinolaryngol 2015;79:23–25.PubMedCrossRef
106.
107.
Bassi M et al. Large diameter fully covered self-expanding metal stent placement for palliation of proximal malignant esophageal strictures. Dis Esophagus 2015;28:579–584.PubMedCrossRef
108.
Johnson E et al. Survival and complications after insertion of self-expandable metal stents for malignant oesophageal stenosis. Scand J Gastroenterol 2006;41:252–256.PubMedCrossRef
109.
Bethge N, Vakil N. A prospective trial of a new self-expanding plastic stent for malignant esophageal obstruction. Am J Gastroenterol 2001;96:1350–1354.PubMedCrossRef
110.
Costamagna G et al. Prospective evaluation of a new self-expanding plastic stent for inoperable esophageal strictures. Surg Endosc 2003;17:891–895.PubMedCrossRef
111.
Evrard S et al. Self-expanding plastic stents for benign esophageal lesions. Gastrointest Endosc 2004;60:894–900.PubMedCrossRef
112.
Sigounas DE, Siddhi S, Plevris JN. Biodegradable esophageal stents in benign and malignant strictures—a single center experience. Endosc Int Open 2016;4:E618–E623.PubMedPubMedCentralCrossRef
113.
Vandenplas Y et al. A biodegradable esophageal stent in the treatment of a corrosive esophageal stenosis in a child. J Pediatr Gastroenterol Nutr 2009;49:254–257.PubMedCrossRef
114.
Repici A et al. Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 2010;72:927–934.PubMedCrossRef
115.
Kochhar R et al. Biodegradable stents for caustic esophageal strictures: do they work? Dysphagia 2017;32:575–582.PubMedCrossRef
116.
Adler DG. Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture. Gastrointest Endosc 2017;85:1291–1293.PubMedCrossRef
117.
Klapheke R, Eskandari A, Chang MA. Creation of an esophageal jejunal anastomosis for a blind esophagus using a lumen-apposing metal stent. VideoGIE 2020;5:233–234.PubMedPubMedCentralCrossRef
118.
Yasuda JL et al. Endoscopic incisional therapy and other novel strategies for effective treatment of congenital esophageal stenosis. J Pediatr Surg 2020;55:2342–2347.PubMedCrossRef
119.
Ohtaka M et al. Use of Sato’s curved laryngoscope and an insulated-tip knife for endoscopic incisional therapy of esophageal web. Dig Endosc 2015;27:522–526.PubMedCrossRef
120.
Metadata
Title
Endoscopic Management of Luminal Strictures: Beyond Dilation
Authors
Nader D. Daoud
Hassan Ghoz
Obaie Mzaik
Himesh B. Zaver
Micah McKinney
Bhaumik Brahmbhatt
Timothy Woodward
Publication date
25-02-2022
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 5/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-022-07396-w

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