Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
Endoscopy. 2013;45(4):316-9. doi: 10.1055/s-0032-1326016. Epub 2013 Jan 23.
Strictures remaining after nonsurgical treatment for esophageal cancer are generally more refractory to endoscopic balloon dilation (EBD) when compared with anastomotic strictures. The aim of the present study was to evaluate the efficacy and safety of a radial incision and cutting (RIC) method for the treatment of refractory strictures after nonsurgical treatment of esophageal cancer. All subjects complained of grade 2 or worse dysphagia, even after at least 10 sessions of EBD. Between August 2009 and May 2012, eight consecutive patients with refractory esophageal stricture after nonsurgical treatments, including chemoradiotherapy (CRT) alone (n = 3), CRT followed by salvage endoscopic treatment (n = 3), or endoscopic submucosal dissection (ESD; n = 2), underwent the RIC procedure. After the RIC procedure, dysphagia in all the patients dramatically improved to grade 1 or 0 without any major complications; however, the long-term efficacy was unfavorable as only 37.5 % (3 /8) demonstrated adequate lumen patency at 3 months, and re-intervention was necessary in six patients (75 %).
与吻合口狭窄相比，非手术治疗后的食管癌遗留狭窄通常对内镜球囊扩张（EBD）更具难治性。本研究旨在评估经皮内镜下胃造瘘术（RIC）治疗非手术治疗后食管癌难治性狭窄的疗效和安全性。所有患者均诉至少接受了 10 次 EBD 后仍存在 2 级或更严重的吞咽困难。2009 年 8 月至 2012 年 5 月，连续 8 例非手术治疗后出现难治性食管狭窄的患者（单纯放化疗 3 例、放化疗后挽救性内镜治疗 3 例、内镜黏膜下剥离术 2 例）接受了 RIC 手术。RIC 手术后，所有患者的吞咽困难均显著改善至 1 级或 0 级，无任何重大并发症；然而，长期疗效并不理想，仅 37.5%（3/8）的患者在 3 个月时显示出足够的管腔通畅性，6 例患者（75%）需要再次介入治疗。
