DiSario James A, Pedersen Peder J, Bichiş-Canoutas Cristina, Alder Stephen C, Fang John C
Department of Gastroenterology, Hepatology and Nutrition, University of Utah Health Sciences Center and Veterans Affairs Medical Center, Salt Lake City, 84132, USA.
Gastrointest Endosc. 2002 Aug;56(2):244-8. doi: 10.1016/s0016-5107(02)70185-5.
Distal esophageal (Schatzki) ring is a frequent cause of dysphagia. Bougienage is generally effective but relapse is common. Outcomes for patients treated by endoscopic incision of distal esophageal rings after symptomatic relapses after bougienage are described.
Eleven patients (2 women, 9 men; median age 61 years; range 24 to 81 years) with recurrent dysphagia after bougienage with large caliber bougies underwent 17 sessions of endoscopic incision of the rings. Follow-up was by standardized interview at a median of 55 months (range, 7 to 84 months) after the initial incision procedure.
A median of 3 dilation sessions (range, 1 to >25) were performed prior to incision. All patients noted complete resolution of dysphagia immediately thereafter. Seven required subsequent incision or dilation and 4 did not. The mean dysphagia score was significantly improved from that before incision to that during follow-up. There was a significant increase in the mean duration of improvement in dysphagia after the initial incision compared with that after preincision dilation (respectively, 17 months [range, 2 to 72 months] vs. 5 months [range, 0.5 to 28 months]; p = 0.034).
Endoscopic incision of distal esophageal rings that cause recurrent dysphagia after bougienage improves dysphagia and provides a longer dysphagia-free interval compared with repeated bougienage.
食管远端（沙茨基）环是吞咽困难的常见原因。探条扩张术通常有效，但复发很常见。本文描述了在探条扩张术后症状复发的患者中，经内镜切开食管远端环的治疗结果。
11例（2例女性，9例男性；中位年龄61岁；范围24至81岁）在使用大口径探条进行探条扩张术后出现复发性吞咽困难的患者接受了17次内镜下食管环切开术。在初次切开术后中位55个月（范围7至84个月）通过标准化访谈进行随访。
在切开术前中位进行了3次扩张术（范围1至>25次）。此后所有患者均指出吞咽困难立即完全缓解。7例患者需要后续切开或扩张，4例不需要。吞咽困难平均评分从切开术前到随访期间有显著改善。与切开术前扩张后相比，初次切开术后吞咽困难改善的平均持续时间显著增加（分别为17个月[范围2至72个月]对5个月[范围0.5至28个月]；p = 0.034）。
对于探条扩张术后导致复发性吞咽困难的食管远端环，内镜下切开术可改善吞咽困难，并与重复探条扩张术相比提供更长的无吞咽困难间隔期。
