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01-02-2020 | Original Article

Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies

Authors: Rakesh Kochhar, Sarthak Malik, Yalaka Rami Reddy, Usha Dutta, Narendra Dhaka, Saroj Kant Sinha, Bipadabhanjan Mallick, T. D. Yadav, Vikas Gupta

Published in: Dysphagia | Issue 1/2020

Abstract

Background and Aims

This retrospective study was aimed at assessing the efficacy of endoscopic dilation for esophageal anastomotic strictures, and to compare response between caustic anastomotic strictures (CAS) and non-caustic anastomotic strictures (NCAS).

Materials and Methods

Patients with anastomotic strictures (enrolled during January 1996–December 2015) were analyzed. Short- and long-term outcomes of dilation, in terms of clinical success, refractory, and recurrent strictures were compared between NCAS and CAS. Patients with refractory and recurrent strictures were managed with adjunctive therapy including intralesional steroids. Factors predicting refractoriness at start of dilation and reasons for more than ten lifetime dilations were also evaluated.

Results

Of the 142 patients, 124 (mean age—44.02; males—74) underwent dilation. Clinical success was achieved in 113 (91.3%) patients requiring a median [Interquartile range (IQR)] of 4 (2–10) sessions. The number of dilations to achieve clinical success, refractory strictures, and recurrent strictures, and the use of adjunctive therapy were significantly higher for CAS than for NCAS. Intralesional steroid use decreased periodic dilation index (PDI) significantly in CAS. Caustic etiology and starting dilation diameter of < 10 mm were found to be predictors of refractoriness, with the former alone being an independent predictor of more than ten lifetime dilations. No patient had free perforation; however, five required revision surgery.

Conclusion

Patients with CAS fared worse than those with NCAS in terms of number of dilations, refractoriness, recurrence of strictures, and need of adjunctive therapy. Endoscopic dilation can successfully ameliorate dysphagia due to anastomotic strictures in a majority of patients.

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Title: Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies
Authors: Rakesh Kochhar
Sarthak Malik
Yalaka Rami Reddy
Usha Dutta
Narendra Dhaka
Saroj Kant Sinha
Bipadabhanjan Mallick
T. D. Yadav
Vikas Gupta
Publication date: 01-02-2020
Publisher: Springer US
Published in: Dysphagia / Issue 1/2020
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-019-10004-1

At a glance: The STEP trials

Springer Medicine

Outcomes of Endoscopic Dilation in Patients with Esophageal Anastomotic Strictures: Comparison Between Different Etiologies

Abstract

Background and Aims

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and Aims

Materials and Methods

Results

Conclusion

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