Esophageal stricture surgery: Difference between revisions

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{{Esophageal stricture}}
{{Esophageal stricture}}
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==Overview==
==Overview==
Surgical intervention is not recommended for the management of [disease name].
The mainstay of treatment for [[esophageal stricture]] is [[dilation]]. [[Proton pump inhibitor|Proton pump inhibitors]] or [[Histamine-2 receptor blocker|H2 antagonists]] are recommended among all patients  who develop [[esophageal]] [[stricture]] due to [[gastroesophageal reflux disease]]. Self-expandable plastic or metal [[Stent|stents]] placement is indicated for patients with refractory [[esophageal]] [[stricture]]. [[Surgery]] is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of [[dysphagia]], extraesophageal manifestations and long term [[side effects]] of medical therapy


OR
==Surgery==
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR


The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
[[Surgery]] is not the [[first-line treatment]] option for patients with [[esophageal]] [[stricture]] because it can lead to serious morbidity and mortality. <ref name="pmid21346853">{{cite journal |vauthors=Baron TH |title=Management of benign esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=1 |pages=46–9 |year=2011 |pmid=21346853 |pmc=3038317 |doi= |url=}}</ref>


OR
[[Surgery]] is usually reserved for patients with either:<ref name=":0">{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref>
* Inability to [[dilate]] the [[stricture]]
* Frequent recurrence of [[dysphagia]]
* [[Esophagitis]] refractory to medical therapy
* Extraesophageal manifestations such as [[aspiration pneumonia]]
* Long term [[side effects]] of medical therapy in young patients.


Surgery is the mainstay of treatment for [disease or malignancy].
Some methods of [[surgery]] are included:  
==Surgery==
* [[Laparoscopic]] [[esophagectomy]]<ref name=":0" />  
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The most common cause of esophageal stricture is gastroesophageal reflux disease. Treatment for esophageal stricture is combination of dilation and  proton pump inhibitors  or H2 antagonist therapy.<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref>
* Cautious dilation <ref name="pmid15625037">{{cite journal |vauthors=Nostrant TT |title=Esophageal Dilation / Dilators |journal=Curr Treat Options Gastroenterol |volume=8 |issue=1 |pages=85–95 |year=2005 |pmid=15625037 |doi= |url=}}</ref>
** Caustic strictures
** Radiation stricture
** Eosinophilic esophagitis  due to increased risk of perforation
** Bleeding disorders
** Severe cardiovascular disease or pulmonary disease
* Dilators<ref name="pmid15625037" />  <ref name="pmid2382455">{{cite journal |vauthors=Shemesh E, Czerniak A |title=Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures |journal=World J Surg |volume=14 |issue=4 |pages=518–21; discussion 521–2 |year=1990 |pmid=2382455 |doi= |url=}}</ref><ref name="pmid7818628">{{cite journal |vauthors=Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR |title=Balloon or bougie for dilatation of benign esophageal stricture? |journal=Dig. Dis. Sci. |volume=39 |issue=4 |pages=776–81 |year=1994 |pmid=7818628 |doi= |url=}}</ref>     
** Mechanical ( bougie) that can be done with 
*** Guidewire such as savary-gilliard and eder-puestow olive dilators
*** Nonguidewire such as maloney and hurst dilator 
** Balloon dilators
* Self-expandable plastic or metal stents placement for patients with refractory esophageal stricture  <ref name="pmid14716840">{{cite journal |vauthors=Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ |title=Complications of stent placement for benign stricture of gastrointestinal tract |journal=World J. Gastroenterol. |volume=10 |issue=2 |pages=284–6 |year=2004 |pmid=14716840 |pmc=4717021 |doi= |url=}}</ref><ref name="pmid15472671">{{cite journal |vauthors=Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G |title=Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=60 |issue=4 |pages=513–9 |year=2004 |pmid=15472671 |doi= |url=}}</ref>
* Self dilation at home  with bougie dilators <ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref>
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* local steroid injection in refractory strictures by inhibiting collagen formation <ref name="pmid19439958">{{cite journal |vauthors=Pregun I, Hritz I, Tulassay Z, Herszényi L |title=Peptic esophageal stricture: medical treatment |journal=Dig Dis |volume=27 |issue=1 |pages=31–7 |year=2009 |pmid=19439958 |doi=10.1159/000210101 |url=}}</ref>
* Pharyngoesophageal puncture in severe upper esophageal stenosis after radiation therapy for laryngeal and hypopharyngeal cancers  <ref name="pmid19517185">{{cite journal |vauthors=Tang SJ, Singh S, Truelson JM |title=Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos) |journal=Surg Endosc |volume=24 |issue=1 |pages=210–4 |year=2010 |pmid=19517185 |doi=10.1007/s00464-009-0535-y |url=}}</ref>
* [[Brachytherapy]] is recommended among patients with '''malignant''' esophageal stricture with a life expectancy more than three months.<ref name="pmid22534713">{{cite journal |vauthors=Kujawski K, Stasiak M, Rysz J |title=The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer |journal=Med. Sci. Monit. |volume=18 |issue=5 |pages=CR323–9 |year=2012 |pmid=22534713 |pmc=3560635 |doi= |url=}}</ref>
*  Stent placement for malignant esophageal stricture palliative therapy with expected survival less than three months<ref name="pmid22534713" />  
*feeding tube and gastrostomy for patients that  are not good candidate for surgery
OR
*Surgery is not the first-line treatment option for patients with esophageal stricture. Sent placement  is usually reserved for patients with either
**Malignant esophageal strictures with a  life expectancy less than three months<ref name="pmid18250638">{{cite journal |vauthors=Siersema PD |title=Treatment options for esophageal strictures |journal=Nat Clin Pract Gastroenterol Hepatol |volume=5 |issue=3 |pages=142–52 |year=2008 |pmid=18250638 |doi=10.1038/ncpgasthep1053 |url=}}</ref>
**[Indication 2]
**[Indication 3]
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR


*Surgery is the mainstay of treatment for [disease or malignancy].
* Pharyngoesophageal puncture in severe upper [[esophageal]] [[stenosis]] after [[radiation therapy]] for [[laryngeal]] and [[Hypopharyngeal cancer|hypopharyngeal cancers]]<ref name="pmid19517185">{{cite journal |vauthors=Tang SJ, Singh S, Truelson JM |title=Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos) |journal=Surg Endosc |volume=24 |issue=1 |pages=210–4 |year=2010 |pmid=19517185 |doi=10.1007/s00464-009-0535-y |url=}}</ref>


==Indications==
*[[Esophageal]] surgical [[resection]] via colonic interposition between [[cervical]] [[esophagus]] and [[duodenum]] or [[stomach]] especially after [[caustic]] injury<ref name="pmid1483661">{{cite journal |vauthors=Csendes A, Braghetto I |title=Surgical management of esophageal strictures |journal=Hepatogastroenterology |volume=39 |issue=6 |pages=502–10 |year=1992 |pmid=1483661 |doi= |url=}}</ref><ref name="pmid15334683">{{cite journal |vauthors=Han Y, Cheng QS, Li XF, Wang XP |title=Surgical management of esophageal strictures after caustic burns: a 30 years of experience |journal=World J. Gastroenterol. |volume=10 |issue=19 |pages=2846–9 |year=2004 |pmid=15334683 |pmc=4572115 |doi= |url=}}</ref>


==References==
==References==
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Latest revision as of 21:41, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

The mainstay of treatment for esophageal stricture is dilation. Proton pump inhibitors or H2 antagonists are recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Self-expandable plastic or metal stents placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of dysphagia, extraesophageal manifestations and long term side effects of medical therapy

Surgery

Surgery is not the first-line treatment option for patients with esophageal stricture because it can lead to serious morbidity and mortality. [1]

Surgery is usually reserved for patients with either:[2]

Some methods of surgery are included:

References

  1. ↑ Baron TH (2011). "Management of benign esophageal strictures". Gastroenterol Hepatol (N Y). 7 (1): 46–9. PMC 3038317. PMID 21346853.
  2. ↑ 2.0 2.1 Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.
  3. ↑ Tang SJ, Singh S, Truelson JM (2010). "Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos)". Surg Endosc. 24 (1): 210–4. doi:10.1007/s00464-009-0535-y. PMID 19517185.
  4. ↑ Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.
  5. ↑ Han Y, Cheng QS, Li XF, Wang XP (2004). "Surgical management of esophageal strictures after caustic burns: a 30 years of experience". World J. Gastroenterol. 10 (19): 2846–9. PMC 4572115. PMID 15334683.

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