Esophageal stricture procedure: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Esophageal stricture}} | {{Esophageal stricture}} | ||
{{CMG}};{{AE}}{{MA}} | {{CMG}};{{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for | 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 [[Stent|metal stents]] placement is indicated for patients with refractory esophageal stricture. | ||
==Esophageal stricture procedure== | ==Esophageal stricture procedure== | ||
The most common cause of esophageal stricture is [[gastroesophageal reflux disease]]. Treatment for | The most common cause of esophageal stricture is [[gastroesophageal reflux disease]]. Treatment for esophageal stricture is combination of [[dilation]] and [[Proton pump inhibitor|proton pump inhibitors]] or [[Histamine-2 receptor blocker|H2 antagonist therapy]].<ref name="pmid79264952">{{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> | ||
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Interventions for treatment of | Interventions for treatment of esophageal stricture<nowiki/>s include: | ||
*Dilators | *Dilators | ||
*[[Stent]]<nowiki/>s | *[[Stent]]<nowiki/>s | ||
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=== Stents === | === Stents === | ||
Self-expandable plastic or | Self-expandable plastic or [[stent|metal stent<nowiki/>s]] can be used 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> | ||
[[Stent]] can be considered for [[malignant]] | [[Stent]] can be considered for [[malignant]] esophageal stricture as a [[palliative therapy]] with expected survival time less 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><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> | ||
=== '''Brachytherapy''' === | === '''Brachytherapy''' === | ||
[[Brachytherapy]] is recommended among patients with '''[[malignant]]''' | [[Brachytherapy]] is recommended among patients with '''[[malignant]]''' esophageal stricture with a life expectancy more than three months.<ref name="pmid22534713" /> | ||
=== Feeding tube and gastrostomy === | === Feeding tube and gastrostomy === | ||
Revision as of 20:22, 22 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] [3]
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.
Esophageal stricture procedure
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.[1]
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Interventions for treatment of esophageal strictures include:
- Dilators
- Stents
- Brachytherapy
- Feeding tube and gastrostomy
- Fundoplication to control reflux[2]
- Local steroid injection via endoscopy can be used in refractory strictures. It inhibits collagen formation.[3]
Dilators
There are two main forms of dilation including:[4][5][6]
- 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
Patients can use bougie dilators as self dilation at home[7]
The following conditions need more cautious dilation because of increased risk of rupture and severity of underlying disease. [8]
- Caustic strictures
- Radiation stricture
- Eosinophilic esophagitis
- Bleeding disorders
- Severe cardiovascular disease or pulmonary disease
Stents
Self-expandable plastic or metal stents can be used for patients with refractory esophageal stricture[9][10]
Stent can be considered for malignant esophageal stricture as a palliative therapy with expected survival time less than three months[11][12]
Brachytherapy
Brachytherapy is recommended among patients with malignant esophageal stricture with a life expectancy more than three months.[11]
Feeding tube and gastrostomy
Feeding tube and gastrostomy can be done for patients that are not good candidate for surgery [13]
References
- ↑ Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
- ↑ Lundell, Lars (16 May 2006). "Reflux esophagitis and peptic strictures". GI Motility online. doi:10.1038/gimo43.
- ↑ Pregun I, Hritz I, Tulassay Z, Herszényi L (2009). "Peptic esophageal stricture: medical treatment". Dig Dis. 27 (1): 31–7. doi:10.1159/000210101. PMID 19439958.
- ↑ Nostrant TT (2005). "Esophageal Dilation / Dilators". Curr Treat Options Gastroenterol. 8 (1): 85–95. PMID 15625037.
- ↑ Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR (1994). "Balloon or bougie for dilatation of benign esophageal stricture?". Dig. Dis. Sci. 39 (4): 776–81. PMID 7818628.
- ↑ Shemesh E, Czerniak A (1990). "Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures". World J Surg. 14 (4): 518–21, discussion 521–2. PMID 2382455.
- ↑ Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
- ↑ Nostrant TT (2005). "Esophageal Dilation / Dilators". Curr Treat Options Gastroenterol. 8 (1): 85–95. PMID 15625037.
- ↑ Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2004). "Complications of stent placement for benign stricture of gastrointestinal tract". World J. Gastroenterol. 10 (2): 284–6. PMC 4717021. PMID 14716840.
- ↑ Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G (2004). "Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures". Gastrointest. Endosc. 60 (4): 513–9. PMID 15472671.
- ↑ 11.0 11.1 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.
- ↑ Siersema PD (2008). "Treatment options for esophageal strictures". Nat Clin Pract Gastroenterol Hepatol. 5 (3): 142–52. doi:10.1038/ncpgasthep1053. PMID 18250638.
- ↑ 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.