Mitani Yosuke, Hirohashi Kenshiro, Tamaoki Masashi, Yokoyama Akira, Katada Chikatoshi, Ueda Aya, Yamahigashi Natsuko, Higuchi Hirokazu, Muto Manabu
Therapeutic Oncology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.
Medical Supply, Kyoto University Hospital, Kyoto, Japan.
Endosc Int Open. 2024 Sep 10;12(9):E1035-E1042. doi: 10.1055/a-2382-6213. eCollection 2024 Sep.
Radial incision and cutting (RIC) was established to improve refractory esophageal anastomotic strictures but its efficacy and safety for nonsurgical refractory strictures remain unclear. To evaluate the usefulness of RIC in nonsurgical refractory strictures, we retrospectively compared outcomes between nonsurgical and surgical strictures. We retrospectively studied 54 consecutive patients who were initially treated with RIC for refractory benign esophageal stricture. The study variables included dysphasia score improvement rate, frequency of repeated RIC, cumulative patency rate, cumulative stricture improved rate, and adverse events(AEs), which were compared between nonsurgical (n = 21) and surgical (n = 33) stricture groups. Immediately after RIC, 90.5% of patients in the nonsurgical group and 84.8% of patients in the surgical group had improvement in dysphagia ( = 0.69). The frequency of intervening repeated RIC was 42.9% in the nonsurgical group and 42.4% in the surgical group ( = 0.98). During median follow-up of 22.3 months (range, 1.0-175.0), the cumulative patency rate ( = 0.23) and cumulative stricture improvement rate ( = 0.14) but there was not statistical difference between the two groups. Despite a low cumulative stricture improvement rate (9.5%) at 6 months after the first RIC in the nonsurgical group, 57.7% of patients no longer required endoscopic balloon dilatation at 2 years. The cumulative stricture improvement rate was significantly lower in patients with a history of radiation therapy. No severe AEs were observed in the nonsurgical group. RIC for nonsurgical refractory benign esophageal stricture is an effective and safe treatment option.
为改善难治性食管吻合口狭窄而建立了放射状切开与切除（RIC）术，但其对非手术难治性狭窄的疗效和安全性仍不明确。为评估RIC在非手术难治性狭窄中的效用，我们回顾性比较了非手术和手术狭窄患者的治疗结果。我们回顾性研究了54例连续接受RIC治疗难治性良性食管狭窄的患者。研究变量包括吞咽困难评分改善率、RIC重复频率、累积通畅率、累积狭窄改善率和不良事件（AE），并在非手术组（n = 21）和手术组（n = 33）之间进行比较。RIC术后即刻，非手术组90.5%的患者和手术组84.8%的患者吞咽困难得到改善（P = 0.69）。非手术组干预性重复RIC的频率为42.9%，手术组为42.4%（P = 0.98）。在中位随访22.3个月（范围1.0 - 175.0个月）期间，两组间累积通畅率（P = 0.23）和累积狭窄改善率（P = 0.14）无统计学差异。尽管非手术组首次RIC术后6个月累积狭窄改善率较低（9.5%），但57.7%的患者在2年时不再需要内镜球囊扩张。有放疗史的患者累积狭窄改善率显著较低。非手术组未观察到严重不良事件。RIC治疗非手术难治性良性食管狭窄是一种有效且安全的治疗选择。
