TY - JOUR
T1 - Intensive endoscopic therapy for untreated cervical anastomotic strictures after esophagectomy
T2 - a pilot study
AU - van Halsema, Emo E.
AU - Bergman, Jacques J. G. H. M.
AU - van Sandick, Johanna W.
AU - van Berge Henegouwen, Mark I.
AU - Cats, Annemieke
AU - Veenhof, Alexander A. F. A.
AU - van Hooft, Jeanin E.
AU - van Dieren, Jolanda M.
N1 - Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022
Y1 - 2022
N2 - Background: Cervical anastomotic strictures after esophagectomy cause significant disease burden. We aimed to study the technical feasibility and safety of intensive endoscopic therapy. Methods: In this pilot study, we included 15 patients with an untreated benign cervical anastomotic stricture after esophagectomy. Intensive endoscopic therapy comprised three endoscopic modalities: in- and excision using a needle-knife, intralesional steroid injections and bougie dilation. In two endoscopic procedures, the stricture was dilated up to a luminal diameter of 18 mm. Patients were followed up to 6 months. Results: A luminal diameter of 18 mm was achieved in 13 of 15 patients (87%) after two endoscopic procedures. No major adverse events related to the investigational treatment occurred. Median dysphagia scores significantly improved from 2 (IQR, interquartile range, 2–3) at baseline to 0 (IQR 0–1) after 14 days (p < 0.001). Eleven (73%) patients developed recurrent symptoms of dysphagia requiring a median of 1 (IQR 0–3) additional endoscopic dilation procedure. Conclusions: Achieving a luminal diameter of 18 mm in two procedures with intensive endoscopic therapy was technically feasible and effective in reducing dysphagia rapidly in patients with a cervical anastomotic stricture after esophagectomy. No major adverse events related to the investigational treatment were observed.
AB - Background: Cervical anastomotic strictures after esophagectomy cause significant disease burden. We aimed to study the technical feasibility and safety of intensive endoscopic therapy. Methods: In this pilot study, we included 15 patients with an untreated benign cervical anastomotic stricture after esophagectomy. Intensive endoscopic therapy comprised three endoscopic modalities: in- and excision using a needle-knife, intralesional steroid injections and bougie dilation. In two endoscopic procedures, the stricture was dilated up to a luminal diameter of 18 mm. Patients were followed up to 6 months. Results: A luminal diameter of 18 mm was achieved in 13 of 15 patients (87%) after two endoscopic procedures. No major adverse events related to the investigational treatment occurred. Median dysphagia scores significantly improved from 2 (IQR, interquartile range, 2–3) at baseline to 0 (IQR 0–1) after 14 days (p < 0.001). Eleven (73%) patients developed recurrent symptoms of dysphagia requiring a median of 1 (IQR 0–3) additional endoscopic dilation procedure. Conclusions: Achieving a luminal diameter of 18 mm in two procedures with intensive endoscopic therapy was technically feasible and effective in reducing dysphagia rapidly in patients with a cervical anastomotic stricture after esophagectomy. No major adverse events related to the investigational treatment were observed.
KW - Anastomosis
KW - Benign esophageal strictures
KW - Endoscopic dilation
KW - Endoscopic therapy
KW - Esophagectomy
KW - Esophagus
UR - http://www.scopus.com/inward/record.url?scp=85141050646&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-022-09731-8
DO - https://doi.org/10.1007/s00464-022-09731-8
M3 - Article
C2 - 36282358
SN - 0930-2794
JO - Surgical endoscopy
JF - Surgical endoscopy
ER -