Endoscopic incisional therapy for benign esophagealstrictures： Technique and results

• 作者: Jayanta Samanta Narendra Dhaka Rakesh Kochhar Saroj Kant Sinha
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ENDOSCOPIC INCISIONAL THERAPY Esophagealstrictures Anastomotic STRICTURES Needle KNIFE Radialincision and cutting
• 年，卷（期）: 2015,（19）
• 页码范围: 1318-1326
• 页数: 9页
• 分类号: R

摘要

Benign esophageal strictures refractory to the conventionalballoon or bougie dilatation may be subjected to variousadjunctive modes of therapy, one of them beingendoscopic incisional therapy （EIT）. A proper delineationof the stricture anatomy is a prerequisite. A host ofelectrocautery and mechanical devices may be used,the most common being the use of needle knife, eitherstandard or insulated tip. The technique entails radialincision and cutting off of the stenotic rim. Adjunctivetherapies, to prevent re-stenosis, such as balloon dilatation,oral or intralesional steroids or argon plasma coagulationcan be used. The common strictures where EIT has beensuccessfully used are Schatzki＇s rings （SR） and anastomoticstrictures （AS）. Short segment strictures （〈 1 cm） havebeen found to have the best outcome. When comparedwith routine balloon dilatation, EIT has equivalent resultsin treatment na？ve cases but better long term outcomein refractory cases. Anecdotal reports of its use in othertypes of strictures have been noted. Post procedurecomplications of EIT are mild and comparable to dilatationtherapy. As of the current evidence, incisional therapy canbe used for management of refractory AS and SR withrelatively short stenosis （〈 1 cm） with good safety profileand acceptable long term patency.