Kahalekar Vinit, Gupta Deepak Trilokinath, Bhatt Pratin, Shukla Akash, Bhatia Shobna
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Parel, Mumbai, 400 012, India.
Indian J Gastroenterol. 2017 May;36(3):197-201. doi: 10.1007/s12664-017-0764-2. Epub 2017 Jul 4.
Treatment options for benign refractory esophageal stricture are limited. We retrospectively analyzed data of 11 patients who underwent fully covered self-expanding metallic stent (FC-SEMS) placement for refractory benign esophageal stricture at our institute.
Refractory benign esophageal stricture was defined as inability to dilate a stricture to a diameter of 14 mm after a minimum of five sessions at 2-week intervals or inability to maintain diameter of 14 mm for at least 4 weeks. Eleven patients with refractory benign esophageal stricture (corrosive-6, peptic-3, and post-sclerotherapy-2) underwent FC-SEMS placement. The stent was removed after 4-6 weeks as per manufacturer's recommendation. Patients were followed up for 1 year.
Three patients with peptic strictures [length of stricture 2, 3, and 3 cm] and two patients with post-sclerotherapy stricture [length 2 and 1.5 cm] had complete response. Two of 6 patients with corrosive stricture (10 cm, 12 cm) developed recurrence of symptoms within 1 month of stent removal, and two after 2 months (8 cm, 3 cm). One patient with corrosive stricture (6 cm) had recurrence after 6 months, and responded to single session of dilatation. One patient with corrosive stricture was asymptomatic for last 12 months. Four stents were migrated. Four patients developed severe retrosternal pain following stent placement, which was managed with analgesics. There were no serious adverse events after placement of stent and removal of stent.
Fully covered SEMS is safe and effective for refractory benign non-corrosive esophageal strictures.
良性难治性食管狭窄的治疗选择有限。我们回顾性分析了在我院接受完全覆盖自膨式金属支架（FC-SEMS）置入术治疗难治性良性食管狭窄的11例患者的数据。
难治性良性食管狭窄定义为在至少每隔2周进行5次扩张后仍无法将狭窄扩张至直径14毫米，或无法将直径维持在14毫米至少4周。11例难治性良性食管狭窄患者（腐蚀性狭窄6例、消化性狭窄3例、硬化治疗后狭窄2例）接受了FC-SEMS置入术。根据制造商的建议，在4-6周后取出支架。对患者进行了1年的随访。
3例消化性狭窄患者[狭窄长度分别为2厘米、3厘米和3厘米]和2例硬化治疗后狭窄患者[长度分别为2厘米和1.5厘米]完全缓解。6例腐蚀性狭窄患者中有2例（狭窄长度分别为10厘米、12厘米）在支架取出后1个月内症状复发，2例在2个月后（狭窄长度分别为8厘米、3厘米）复发。1例腐蚀性狭窄患者（狭窄长度6厘米）在6个月后复发，经单次扩张后缓解。1例腐蚀性狭窄患者在过去12个月内无症状。4枚支架发生移位。4例患者在支架置入后出现严重的胸骨后疼痛，经止痛治疗。支架置入和取出后均未发生严重不良事件。
完全覆盖的SEMS对难治性良性非腐蚀性食管狭窄安全有效。
