Rodrigues-Pinto Eduardo, Pereira Pedro, Ribeiro Armando, Lopes Susana, Moutinho-Ribeiro Pedro, Silva Marco, Peixoto Armando, Gaspar Rui, Macedo Guilherme
Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal.
Eur J Gastroenterol Hepatol. 2016 Jun;28(6):684-8. doi: 10.1097/MEG.0000000000000594.
Benign esophageal strictures need repeated dilatations to relieve dysphagia. Literature is scarce on the risk factors for refractoriness of these strictures.
This study aimed to assess the risk factors associated with refractory strictures.
This is a retrospective study of patients with benign esophageal strictures who were referred for esophageal dilatation over a period of 3 years.
A total of 327 esophageal dilatations were performed in 103 patients; 53% of the patients reported dysphagia for liquids. Clinical success was achieved in 77% of the patients. There was a need for further dilatations in 54% of patients, being more frequent in patients with dysphagia for liquids [78 vs. 64%, P=0.008, odds ratio (OR) 1.930], in those with caustic strictures (89 vs. 70%, P=0.007, OR 3.487), and in those with complex strictures (83 vs. 70%, P=0.047, OR 2.132). Caustic strictures, peptic strictures, and complex strictures showed statistical significance in the multivariate analysis. Time until subsequent dilatations was less in patients with dysphagia for liquids (49 vs. 182 days, P<0.001), in those with peptic strictures (49 vs. 98 days, P=0.004), in those with caustic strictures (49 vs. 78 days, P=0.005), and in patients with complex strictures (47 vs. 80 days P=0.009). In multivariate analysis, further dilatations occurred earlier in patients with dysphagia for liquids [hazard ratio (HR) 1.506, P=0.004], in those with peptic strictures (HR 1.644, P=0.002), in those with caustic strictures (HR 1.581, P=0.016), and in patients with complex strictures (HR 1.408, P=0.046).
Caustic, peptic, and complex strictures were associated with a greater need for subsequent dilatations. Time until subsequent dilatations was less in patients with dysphagia for liquids and in those with caustic, peptic, and complex strictures.
良性食管狭窄需要反复扩张以缓解吞咽困难。关于这些狭窄难治性的危险因素的文献较少。
本研究旨在评估与难治性狭窄相关的危险因素。
这是一项对3年内因食管扩张而转诊的良性食管狭窄患者的回顾性研究。
103例患者共进行了327次食管扩张；53%的患者报告有液体吞咽困难。77%的患者取得了临床成功。54%的患者需要进一步扩张，液体吞咽困难的患者更频繁（78%对64%，P = 0.008，优势比[OR]1.930），腐蚀性狭窄患者（89%对70%，P = 0.007，OR 3.487），以及复杂性狭窄患者（83%对70%，P = 0.047，OR 2.132）。腐蚀性狭窄、消化性狭窄和复杂性狭窄在多变量分析中显示出统计学意义。液体吞咽困难的患者（49天对182天，P < 0.001）、消化性狭窄患者（49天对98天，P = 0.004）、腐蚀性狭窄患者（49天对78天，P = 0.005）以及复杂性狭窄患者（47天对80天，P = 0.009）到后续扩张的时间更短。在多变量分析中，液体吞咽困难的患者（风险比[HR]1.506，P = 0.004）、消化性狭窄患者（HR 1.644，P = 0.002）、腐蚀性狭窄患者（HR 1.581，P = 0.016）以及复杂性狭窄患者（HR 1.408，P = 0.046）更早出现进一步扩张。
腐蚀性、消化性和复杂性狭窄与更大的后续扩张需求相关。液体吞咽困难的患者以及腐蚀性、消化性和复杂性狭窄患者到后续扩张的时间更短。
