Nogales Óscar, Clemente Ana, Caballero-Marcos Aránzazu, García-Lledó Javier, Pérez-Carazo Leticia, Merino Beatriz, López-Ibáñez María, Pérez Valderas María Dolores, Bañares Rafael, González-Asanza Cecilia
Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España.
Aparato Digestivo, Hospital General Universitario Gregorio Marañón.
Rev Esp Enferm Dig. 2017 Jul;109(7):510-515. doi: 10.17235/reed.2017.4795/2016.
Benign esophageal strictures are relatively frequent and can severely affect the quality of life of a patient. Stenting has been proposed for the treatment of refractory cases. Lesions affecting the cervical esophagus are more difficult to treat, and the placement of stents in this location has traditionally been restricted due to potential adverse events. The aim of this study was to describe the efficacy and safety of endoscopic stenting in the management of refractory benign cervical esophageal strictures (RBCES) in a single-center cohort study.
We analyzed 12 patients with RBCES (Kochman's criteria) and severe dysphagia. We recorded previous endoscopic treatments, stricture characteristics and demographic data. The two types of stents used were fully covered self-expandable metallic stents (FCSEMS) and uncovered biodegradable stents (BDS). FCSEMS were removed eight weeks after placement, and BDS were followed-up until degradation. We assessed technical and clinical success, rate of stricture recurrence and adverse events.
The mean age of participants was 64 years (range 30-85). A total of 23 stents (13 FCSEMS and 10 BDS) were placed in 12 patients (median 1.92, range 1-4). The technical success rate was 96% (22/23 stents). Eight patients (66.6%) maintained adequate oral intake at the end of follow-up (median 33.3 months, range 3-84 months). Migration was recorded in 7/23 stents (30.4%) and epithelial hyperplasia in 4/23 stents (17.4%). No severe adverse events were noted. All patients complained of minor cervical pain after placement that was well controlled with mild analgesia.
Endoscopic stent therapy seems to be effective and safe in the management of RBCES.
良性食管狭窄相对常见，会严重影响患者的生活质量。对于难治性病例，已提出采用支架置入术进行治疗。影响颈段食管的病变更难治疗，由于存在潜在不良事件，传统上该部位支架置入受到限制。本单中心队列研究的目的是描述内镜下支架置入术治疗难治性良性颈段食管狭窄（RBCES）的疗效和安全性。
我们分析了12例符合RBCES（Kochman标准）且有严重吞咽困难的患者。记录既往内镜治疗情况、狭窄特征和人口统计学数据。使用的两种支架分别是全覆膜自膨式金属支架（FCSEMS）和无覆膜可生物降解支架（BDS）。FCSEMS在置入8周后取出，BDS随访至降解。我们评估了技术成功率、临床成功率、狭窄复发率和不良事件。
参与者的平均年龄为64岁（范围30 - 85岁）。12例患者共置入23枚支架（13枚FCSEMS和10枚BDS）（中位数1.92，范围1 - 4）。技术成功率为96%（22/23枚支架）。8例患者（66.6%）在随访结束时（中位数33.3个月，范围3 - 84个月）维持了足够的经口摄入量。23枚支架中有7枚（30.4%）发生移位，4枚（17.4%）出现上皮增生。未观察到严重不良事件。所有患者在置入后均主诉颈部轻微疼痛，使用轻度镇痛药后得到良好控制。
内镜支架治疗在RBCES的管理中似乎有效且安全。
