Saeed K M, Khattak S, Syed A A, Yusuf M A
Shaukat Khanum Memorial cancer hospital and research centre, Internal Medicine department, 7-A, Block r-3 Johar Town, Lahore, Pakistan.
Acta Gastroenterol Belg. 2018 Jul-Sep;81(3):361-365.
Benign oesophageal strictures can arise in the treatment of oesophageal cancer as a result of radiation therapy, or at anastomotic sites, post-oesophagectomy. Data on the benefit of stenting of these types of stricture is limited. We analyzed the effects of oesophageal stents on such benign esophageal strictures. In this retrospective study, data was obtained from consecutive patients, 18 years and above from January 2000 to May 2016. Inclusion criteria comprised of oesophageal stenting in post-radiation strictures and anastomotic strictures, without any malignant residual disease. 17 patients had 22 stents inserted. 11 of these were female. 17 stents were self-expanding metallic stents (SEMS) and five were biodegradable (BDS). 12 strictures occurred post-radiation, while five were anastomotic strictures. Technical and clinical success rates were 100% and 86.4% respectively. Overall longterm clinical success was 45.5% (47% for BDS, 40% for SEMS). Minor, short-term complications, including pain and/or vomiting, were observed in 54.6% (n=12). The overall mean dysphagia score pre- and post-stenting was 2.95 and 1.36 (p=0.0001). Comparison of the dysphagia free survival for anastomotic and post-radiation strictures was statistically similar (p=0.22), as was the dysphagia free survival comparison between BDS and SEMS (p=0.055). BDS and SEMS are a safe and effective treatment modality for oesophageal strictures arising post-radiation or at the site of anastomoses. Retrospective study design and a low number of patients remain limiting factors of the study.
良性食管狭窄可在食管癌治疗过程中因放射治疗而出现，或在食管切除术后的吻合部位出现。关于这类狭窄置入支架的益处的数据有限。我们分析了食管支架对这类良性食管狭窄的影响。在这项回顾性研究中，数据来自2000年1月至2016年5月连续纳入的18岁及以上患者。纳入标准包括对放疗后狭窄和吻合口狭窄进行食管支架置入，且无任何恶性残留病灶。17例患者置入了22个支架。其中11例为女性。17个为自膨式金属支架（SEMS），5个为可生物降解支架（BDS）。12例狭窄发生在放疗后，5例为吻合口狭窄。技术成功率和临床成功率分别为100%和86.4%。总体长期临床成功率为45.5%（BDS为47%，SEMS为40%）。54.6%（n = 12）的患者出现了轻微的短期并发症，包括疼痛和/或呕吐。置入支架前后吞咽困难评分的总体平均值分别为2.95和1.36（p = 0.0001）。吻合口狭窄和放疗后狭窄的无吞咽困难生存期比较在统计学上相似（p = 0.22），BDS和SEMS之间的无吞咽困难生存期比较也是如此（p = 0.055）。BDS和SEMS是治疗放疗后或吻合口部位出现的食管狭窄的一种安全有效的治疗方式。回顾性研究设计以及患者数量较少仍是本研究的限制因素。
