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良性难治性食管狭窄的内镜治疗

Endoscopic management of benign recalcitrant esophageal strictures.

作者信息

Boregowda Umesha, Goyal Hemant, Mann Rupinder, Gajendran Mahesh, Patel Sandeep, Echavarria Juan, Sayana Hari, Saligram Shreyas

机构信息

Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY (Umesha Boregowda).

Department of Medicine, The Wright Center for Graduation Medical Center, Scranton, PA (Hemant Goyal).

出版信息

Ann Gastroenterol. 2021;34(3):287-299. doi: 10.20524/aog.2021.0585. Epub 2021 Jan 27.

Abstract

Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.

摘要

良性食管狭窄是内镜医师处理的常见临床病症之一。近90%的良性食管狭窄对内镜下扩张治疗有效。然而,有一小部分患者会发展为顽固性狭窄。良性顽固性食管狭窄在药物治疗和内镜治疗方面都很难处理,因为它们对质子泵抑制剂和食管扩张的传统治疗无反应。由于严重吞咽困难,良性顽固性食管狭窄患者发生使人衰弱的营养不良和发病的风险很高。这种情况会给患者带来心理创伤,因为治疗通常会延长且效果不佳。此外,由于需要多次治疗,这可能会给医疗行业带来经济负担。在本文中,我们讨论了良性食管狭窄的分类、循证治疗策略、内镜操作技术以及内镜干预的并发症。我们旨在指导医疗人员处理良性食管狭窄,重点是良性顽固性食管狭窄的内镜管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7091/8079876/0611cd57f394/AnnGastroenterol-34-287-g002.jpg

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