Siersema P D
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
Endoscopy. 2009 Apr;41(4):363-73. doi: 10.1055/s-0029-1214532. Epub 2009 Apr 1.
Benign esophageal strictures are a common problem in endoscopic practice. The predominant symptom of patients is dysphagia. The initial treatment option for a benign esophageal stricture is dilation. A subgroup of strictures, i. e., those that are long (> 2 cm), tortuous, and have a narrow diameter, tend to recur and are therefore called refractory. Temporary stent placement, either with a self-expanding metal stent (SEMS) or a self-expanding plastic stent (SEPS), can be considered in these patients. The results obtained so far are disappointing, with long-term clinical resolution of the stricture achieved in less than 50 % of patients. This is mainly due to hyperplastic tissue ingrowth or overgrowth (experienced with SEMS) and stent migration (SEPS). New stent designs are therefore needed for this indication. Initial results show that biodegradable stents have the promise to be useful for refractory benign esophageal strictures; however, this promise needs to be further elucidated in future studies.
良性食管狭窄是内镜诊疗中的常见问题。患者的主要症状是吞咽困难。良性食管狭窄的初始治疗选择是扩张。有一部分狭窄,即那些长度超过2厘米、呈迂曲状且直径狭窄的狭窄,容易复发,因此被称为难治性狭窄。对于这些患者,可以考虑临时放置支架,无论是自膨式金属支架(SEMS)还是自膨式塑料支架(SEPS)。目前所取得的结果令人失望,不到50%的患者实现了狭窄的长期临床缓解。这主要是由于增生组织向内生长或过度生长(SEMS会出现这种情况)以及支架移位(SEPS)。因此,针对这一适应症需要新的支架设计。初步结果表明,可生物降解支架有望用于难治性良性食管狭窄;然而,这一前景需要在未来的研究中进一步阐明。