Drepper Michael, Bichard Philippe, Frossard Jean-Louis
Service de gastroentérologie et d'hépatologie, Département des spécialités de médecine, HUG, 1211 Genève 14.
Rev Med Suisse. 2016 Aug 31;12(528):1410-1414.
Bening strictures of the esophagus are a frequently encountered problem in endoscopy. Dilation by Savary-Gilliard dilators or balloon dilators is the first line treatment and relieves dysphagia in about 75 % of cases. Complex strictures are at higher risk of treatment failure than simple ones and are considered as refractory after repetitive unsuccessful dilations. Adjunction of locally injected corticoids favors outcome in strictures of peptic origin. Further treatment options of refractory strictures are endoscopic incision therapy in short ones and temporary self expandable metallic (SEMS), plastic (SEPS) or biodegradable stent insertion in complex ones. Ultimate rescue treatment consists in self bouginage or esophageal surgery.
食管良性狭窄是内镜检查中经常遇到的问题。使用Savary-Gilliard扩张器或球囊扩张器进行扩张是一线治疗方法，约75%的病例吞咽困难可得到缓解。复杂狭窄比单纯狭窄治疗失败的风险更高，在反复扩张失败后被视为难治性狭窄。局部注射皮质类固醇有助于消化性狭窄的治疗效果。难治性狭窄的进一步治疗选择包括短狭窄采用内镜切开治疗，复杂狭窄采用临时自膨式金属支架（SEMS）、塑料支架（SEPS）或可生物降解支架置入。最终的挽救治疗包括自我探条扩张或食管手术。
