Kochhar Rakesh, Poornachandra Kuchhangi Suresh
Rakesh Kochhar, Kuchhangi Suresh Poornachandra, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
World J Gastrointest Endosc. 2010 Feb 16;2(2):61-8. doi: 10.4253/wjge.v2.i2.61.
Esophageal strictures are a problem frequently encountered by gastroenterologists. Dilation has been the customary treatment for benign esophageal strictures, and dilation techniques have advanced over the years. Depending on their characteristics and the response to treatment, esophageal strictures can be classified into two types: 1, simple (Schatzki rings, webs, peptic injury, and following sclerotherapy) - these are easily amenable to dilation, with a low recurrence rate after initial treatment; and 2, complex (caused by caustic ingestion, radiation injury, anastomotic strictures, and photodynamic therapy) - these are difficult to dilate and are associated with higher recurrence rates. Refractory strictures are those in which it is not possible to relieve the anatomic restriction successfully up to a diameter of 14 mm over five sessions at 2-weekly intervals, due to cicatricial luminal compromise or fibrosis; and recurrent strictures are those in which it is not possible to maintain a satisfactory luminal diameter for 4 wk once the target diameter of 14 mm has been achieved. There are no standard recommendations for the management of refractory strictures. The various techniques used include intralesional steroid injection combined with dilation; endoscopic incisional therapy, with or without dilation; placement of self-expanding metal stents, Polyflex stents, or biodegradable stents; self-bougienage; and endoscopic surgery. This review discusses the indications, technique, results, and complications of the use of intralesional steroid injections combined with dilation and endoscopic incisional therapy with dilation in refractory strictures.
食管狭窄是胃肠病学家经常遇到的问题。扩张一直是治疗良性食管狭窄的常用方法，多年来扩张技术不断发展。根据食管狭窄的特征和对治疗的反应，可将其分为两类：1. 单纯性（沙茨基环、食管蹼、消化性损伤以及硬化治疗后）——这些狭窄易于扩张，初始治疗后复发率低；2. 复杂性（由腐蚀性物质摄入、放射损伤、吻合口狭窄以及光动力治疗引起）——这些狭窄难以扩张，且复发率较高。难治性狭窄是指由于瘢痕性管腔狭窄或纤维化，在每隔2周进行5次扩张治疗后仍无法成功将解剖学狭窄缓解至直径14mm的狭窄；复发性狭窄是指在达到14mm的目标直径后，无法维持满意的管腔直径达4周的狭窄。对于难治性狭窄的管理尚无标准建议。所采用的各种技术包括病灶内注射类固醇联合扩张；内镜切开治疗，可联合或不联合扩张；放置自膨式金属支架、Polyflex支架或可生物降解支架；自我探条扩张；以及内镜手术。本综述讨论了病灶内注射类固醇联合扩张和内镜切开联合扩张治疗难治性狭窄的适应证、技术、结果及并发症。
