Gastroenterology Department, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Gastroenterology Department, Hôpital Saint-Camille, Bry Sur Marne, France.
Surg Endosc. 2022 Aug;36(8):5660-5668. doi: 10.1007/s00464-021-08781-8. Epub 2022 Jul 5.
Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied.
All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery.
During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases.
Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.
腐蚀性食管狭窄内镜扩张疗效的预测因素研究甚少。
纳入 1990 年至 2015 年期间在法国国家参考中心接受内镜扩张治疗的腐蚀性食管狭窄患者。扩张成功定义为能够自主进食，无需进行食管重建手术。
研究期间，共有 894 例患者因腐蚀性物质摄入后住院。其中 101 例发生食管狭窄，92 例符合分析条件（8 例存在缺失数据，1 例患者在接受内镜扩张前死亡）。在该队列中（中位年龄 42 岁，女性占 53%，强碱占 74%，自杀未遂占 77%，水囊使用率 93%），扩张的总体成功率为 57%，中位数扩张次数为 3 次（274 次，范围 1-17 次）。预测该操作成功的因素包括：非炎症性狭窄或狭窄之间的非炎症性镶嵌黏膜（88%比 47%，p=0.001）、单发狭窄与 2 个或更多狭窄（分别为 69%比 47%比 33%，p=0.04）、狭窄长度<5cm（70%比 27%，p<0.001）和存在轻度/中度或非常紧的狭窄（70%比 21%成功，p<0.001）。穿孔率为 6.5%（18/274），2 例需要紧急手术。
腐蚀性食管狭窄的几个特征与内镜扩张的成功率显著相关。我们的数据可能有助于为腐蚀性狭窄患者制定治疗策略。
