Esophageal stricture surgery: Difference between revisions

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* The following conditions need more cautious dilation because of increased risk of rupture and severity of underlying disease. <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 (substance)|Caustic]] strictures
** [[Radiation]] stricture
** Eosinophilic esophagitis  due to increased risk of perforation
** [[Bleeding disorders]]
** Severe [[cardiovascular]] disease or [[pulmonary]] disease
Interventions for treatment of esophageal strictures include:
* Dilators
* Stents
* Brachytherapy
* Surgical interventions
* There are two main forms of dilation including:<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 dilator (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 [[stent]]<nowiki/>s 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 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>  
* 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>  
* [[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>  
* [[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>  

Revision as of 15:15, 8 November 2017

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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

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Indications for surgery[6]

  • 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.


References

  1. ↑ 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.
  2. ↑ 2.0 2.1 Kujawski K, Stasiak M, Rysz J (2012). "The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer". Med. Sci. Monit. 18 (5): CR323–9. PMC 3560635. PMID 22534713.
  3. ↑ Siersema PD (2008). "Treatment options for esophageal strictures". Nat Clin Pract Gastroenterol Hepatol. 5 (3): 142–52. doi:10.1038/ncpgasthep1053. PMID 18250638.
  4. ↑ Yang CW, Lin HH, Hsieh TY, Chang WK (2015). "Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study". BMC Palliat Care. 14: 58. doi:10.1186/s12904-015-0056-5. PMC 4635529. PMID 26542798.
  5. ↑ Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.
  6. ↑ Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.

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