Clinical Endoscopy

Original Article

Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population: Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati, Shailender Singh; Clin Endosc 2017;50(4):366-371. Published online March 17, 2017; DOI: https://doi.org/10.5946/ce.2016.155

Background
/Aims: Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown.
Methods
We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation.
Results
There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated.
Conclusions
Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

Citations

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McKenzie K Allen , Wayne Frei
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Adverse events associated with EGD and EGD-related techniques
Nayantara Coelho-Prabhu, Nauzer Forbes, Nirav C. Thosani, Andrew C. Storm, Swati Pawa, Divyanshoo R. Kohli, Larissa L. Fujii-Lau, Sherif Elhanafi, Audrey H. Calderwood, James L. Buxbaum, Richard S. Kwon, Stuart K. Amateau, Mohammad A. Al-Haddad, Bashar J.
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Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020
Gregorios A. Paspatis, Marianna Arvanitakis, Jean-Marc Dumonceau, Marc Barthet, Brian Saunders, Stine Ydegaard Turino, Angad Dhillon, Maria Fragaki, Jean-Michel Gonzalez, Alessandro Repici, Roy L.J. van Wanrooij, Jeanin E. van Hooft
Endoscopy.2020; 52(09): 792. CrossRef
Acute coronary syndromes in the peri‐operative period after kidney transplantation in United States
Abhinav Goyal, Kevin Bryan Lo, Kshitij Chatterjee, Roy O. Mathew, Peter A. McCullough, Sripal Bangalore, Janani Rangaswami
Clinical Transplantation.2020;[Epub] CrossRef
Five-year single-centre experience of carcinoma of the oesophagus from Blantyre, Malawi
John David Chetwood, Peter J Finch, Anstead Kankwatira, Jane Mallewa, Melita A Gordon, Leo Masamba
BMJ Open Gastroenterology.2018; 5(1): e000232. CrossRef
Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation
Jae Jin Hwang
Clinical Endoscopy.2017; 50(4): 309. CrossRef

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Case Report

An Intractable Caustic Esophageal Stricture Successfully Managed with Sequential Treatment Comprising Incision with an Insulated-Tip Knife, Balloon Dilation, and an Oral Steroid: Woong Ki Lee, Byung Sun Kim, Min A Yang, So Hee Yun, Young Jae Lee, Ji Woong Kim, Jin Woong Cho; Clin Endosc 2016;49(6):560-563. Published online August 12, 2016; DOI: https://doi.org/10.5946/ce.2016.048

Abstract PDF PubReader ePub

Bougie or balloon dilation is a good short-term treatment for caustic esophageal strictures, although recurrence after dilation occurs in approximately 30% of these cases. Therefore, long-term treatment options are required in some cases, and endoscopic incisional therapy has been used for patients with an anastomotic stricture in the gastrointestinal tract. A 58-year-old woman presented with severe swallowing difficulty because of a caustic esophageal stricture, which was caused by accidental exposure to anhydrous acetic acid at infancy. She had undergone several previous bougie and balloon dilations but the stricture did not improve. We performed sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid, which resulted in the patient’s symptoms markedly improving. Thus, we report this case of an intractable caustic esophageal stricture, which was successfully treated using combined endoscopic sequential treatment.

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A new simple endoscopic incision therapy for refractory benign oesophageal anastomotic stricture
Jeongmin Choi, Soo In Choi
BMJ Case Reports.2021; 14(3): e239798. CrossRef
Endoscopic incision for treatment of benign gastrointestinal strictures
Chengbai Liang, Yuyong Tan, Jiaxi Lu, Meixian Le, Deliang Liu
Expert Review of Gastroenterology & Hepatology.2020; 14(6): 445. CrossRef

8,022 View
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2 Web of Science
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Review

Esophageal Stricture Prevention after Endoscopic Submucosal Dissection: Deepanshu Jain, Shashideep Singhal; Clin Endosc 2016;49(3):241-256. Published online March 7, 2016; DOI: https://doi.org/10.5946/ce.2015.099

Abstract PDF PubReader ePub

Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.

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Yang Won Min
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Ning-Li Chai, Jia Feng, Long-Song Li, Sheng-Zhen Liu, Chen Du, Qi Zhang, En-Qiang Linghu
World Journal of Gastroenterology.2018; 24(9): 1046. CrossRef
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Byeong Geun Song, Yang Won Min, Ra Ri Cha, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim
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Dennis Yang, Roxana M. Coman, Michel Kahaleh, Irving Waxman, Andrew Y. Wang, Amrita Sethi, Ashish R. Shah, Peter V. Draganov
Gastrointestinal Endoscopy.2017; 86(4): 600. CrossRef
Esophageal stricture after endoscopic submucosal dissection treated successfully by temporary stent placement
Takahisa Yamasaki, Toshihiko Tomita, Mayu Takimoto, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Jiro Watari, Hiroto Miwa
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Original Article

Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection: Bashar Qumseya, Abraham M. Panossian, Cynthia Rizk, David Cangemi, Christianne Wolfsen, Massimo Raimondo, Timothy Woodward, Michael B. Wallace, Herbert Wolfsen; Clin Endosc 2014;47(2):155-161. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.155

Abstract PDF PubReader ePub

Background/Aims

Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied.

Methods

We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors.

Results

Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007).

Conclusions

Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.

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Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection
Meihong Chen, Yini Dang, Chao Ding, Jiajia Yang, Xinmin Si, Guoxin Zhang
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Kamar Belghazi, Norman Marcon, Christopher Teshima, Kenneth K. Wang, Reza V. Milano, Nahid Mostafavi, Michael B. Wallace, Pujan Kandel, Lady Katherine Mejía Pérez, Michael J. Bourke, Farzan Bahin, Martin A. Everson, Rehan Haidry, Gregory G. Ginsberg, Gene
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Case Report

Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer: Wook Jin Lee, Hwoon-Yong Jung, Do Hoon Kim, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim; Clin Endosc 2013;46(6):643-646. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.643

Abstract PDF PubReader ePub

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.

Citations

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A Case of Esophageal Carcinoma after an Esophageal Reconstruction Operation for Sulfuric Acid Injury: Eun Seo Park, M.D., Suck-Ho Lee, M.D., Chang Kyun Lee, M.D., Bo Yong Jung, M.D., Il-Kwun Chung, M.D., Sun-Joo Kim, M.D., Sang Byung Bae, M.D. and Ji-Hye Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(4):214-218. Published online October 30, 2010

Abstract PDF: Patients with corrosive esophageal strictures have a high risk of developing carcinoma of the esophagus. For this reason, it is often recommended that resection of the esophagus should be considered for chronic caustic strictures in order to prevent the development of carcinoma. A 49-year-old woman who had undergone an esophagogastrectomy due to esophageal caustic stricture at the age of 23 was admitted with a 2-month history of dysphagia. Esophagoscopy showed a benign postoperative stricture in the remnant esophagus. After endoscopic balloon dilation of the stricture, which was about 5 cm in length, an ulcerative mass was noted distal to the stricture. This mass was diagnosed as squamous cell carcionoma. Nearly all the patients with corrosive carcinomas in the published literature had consumed an alkali drink, but our patient had a history of sulfuric acid ingestion. (Korean J Gastrointest Endosc 2010;41:214-218)

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수술 후 문합부 식도 협착에서 내시경적 중재술 후 재협착에 영향을 주는 인자들: Korean J Gastrointest Endosc 2003;27(5):407-407. Published online November 20, 2003

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A Case of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants in Adult: Won Seok Jeong, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Du Rang Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(1):21-25. Published online January 30, 2003

Abstract PDF: Congenital stenosis of the esophagus is a rare form of esophageal stenosis in adults. The main causes of congenital esophageal stenosis are the esophageal web, esophageal stricture due to tracheobronchial remnants, and idiopathic esophageal muscular hypertrophy. Recently we have experienced a 32-year-old male with dysphagia, indigestion, postprandial chest discomfort who was diagnosed as congenital esophageal stenosis due to tracheobronchial remnant. The esophagogram showed stricture of the distal esophagus with secondary proximal dilatation and endoscopic finding revealed marked stenosis on the distal esophagus with normal surrounding mucosa. The esophageal manometric finding showed decreased body peristalsis and incomplete relaxation of the lower esophageal sphincter. The patient was treated by surgical resection of the stenotic segment with end to end anastomosis. We report this rare case of adult type tracheobronchial remnant with analysis of various worldwide report and with brief review of literature. (Korean J Gastrointest Endosc 2003;26:21⁣25)

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증례 : 식도 위장관 ; 악성 식도협착에서의 금속제 확장형 Wallstent 인공식도삽관술 ( Case Reports : Esophagus , Stomach & Intestine ; Self - expanding Wallstent for Palliative Treatment of Malignant Esophageal Stenosis ): Korean J Gastrointest Endosc 1995;15(4):704-711. Published online November 30, 1994

Abstract PDF: The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia. (Kor J Gastrointest Endosc 15: 704-709, 1995)

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증례 : 악성 식도협착에서의 금속제 확장형 EsophaCoilTM 인공식도삽관술 ( Case Reports : Self - Expanding EsophaCoilTM Esophageal Prosthesis for Malignant Esophageal Stenosis ): Korean J Gastrointest Endosc 1995;15(1):63-71. Published online November 30, 1994

Abstract PDF: Endoscopic endoprosthesis is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. But the placement of conventional endoprosthesis is difficult and is associated with significant complications such as hemorrhage, perforation and dysfunction of the prosthesis. Recently, self -expand- able metal prosthesis have also been utilized for malignant esophageal stenosis, and palliation of this modality seems to be more effective than other modalities. However the main problems with these metal stents are tumor ingrowth leading to reobstruction, migration, and eophageal trauma by the distal, hard skirt of the stent. EsophaCoil stent is a simple coil with close loops made from a single flat wire of nickel titanium alloy. The radial force of this material is much stronger than stainless steel, expansion time is faster and the stent is able to dilate even extremely resistant strictures. This new metalic stent seems to have several advantages over the current commnerically available ones. We report our experiences with this EsophaCoil stent and review of literature.

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악성 식도협착에서의 금속제 확장형 UltraflexTM 인공식도삽관술 ( Self - Expanding UltraflexTM Esophageal Prosthesis of Malignant Esophageal Stenosis ): Korean J Gastrointest Endosc 1993;13(1):31-35. Published online November 30, 1992

Abstract PDF: Endoscopic intubation is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. However, the placement of conventional esophageal endopros-thesis is difficult in some cases and this procedure is associated with significant complications such as perforation, hemorrhage and dysfunetion of the prosthesis in the long term. The self-expanding metallic stents offer an attractive alternative to conventional esophageal stents. These can be compressed into and inserted through a small lumen catheter, making placement easier, safer and less painful to patients. But, open mesh of self-expanding metallic stent such as Wallstent allows tumor ingrowth, unfinished wire ends can lead to perforation and bleeding, and immense stent shortening makes precise positioning difficult. Inflammatory response at site of the metal strut, difficulty in retrieving prostheses that place and very expensiveness in cost-benefit analysis are also problems. Recently developed Ultraflex" esophageal prosthesis is knitted from single strand of Elastalloy' wire, undulates to conform with normal esophageal peristalsis, maintaining patency and promoting patient comfort. Unlike other metallic stent that have sharp, bare-wire ends, the Ultraflex' Stent has smooth looped ends, with Teco-flex coating, which provide an atraumatic transition from the stent to the esophageal wall. We experienced a case of a 60-year old male with malignant stenosis of esophageal cancer in whom Ultraflex esophageal prosthesis was implanted with successful oral nutrition.

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