Bell Matthew G, Alexander Jeffrey A, Wong Kee Song Louis M, Codipilly D Chamil, Snyder Diana L, Dierkhising Ross, Ravi Karthik
Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2025 Apr;101(4):772-777. doi: 10.1016/j.gie.2024.10.036. Epub 2024 Oct 28.
Refractory benign esophageal strictures (RBESs) are defined by an inadequate response to dilation. Early recognition of RBESs allows for earlier initiation of aggressive therapy, potentially leading to less morbidity and cost. We sought to establish a predictive model for RBESs.
Patients who underwent EGD with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBESs managed with self-dilation was identified. Malignant strictures, Schatzki's rings, and previously treated strictures were excluded. RBES was defined by the inability to maintain a diameter ≥14 mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBESs.
Of 128 identified patients with an index EGD and esophageal dilation, 25 met the RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of .85, identifying stricture length ≥2 cm, diameter ≤7 mm, and proximal or diffuse stricture location as associated with a higher risk for RBESs. Patients without any of these risk factors had a 2% risk of RBESs, whereas those with all 3 risk factors had a risk of 73% for RBESs.
Risk of RBESs can be predicted at the index EGD based on stricture features. A predictive model for RBESs was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal strictures, potentially reducing morbidity and cost.
难治性良性食管狭窄（RBES）定义为对扩张治疗反应不佳。早期识别RBES有助于更早地开始积极治疗，可能降低发病率并减少费用。我们试图建立一个RBES的预测模型。
确定在梅奥诊所罗切斯特接受食管扩张的内镜检查（EGD）的患者。此外，从一个采用自我扩张治疗的RBES患者临床数据库中确定一组患者。排除恶性狭窄、沙茨基环和既往治疗过的狭窄。RBES定义为在5次扩张治疗后无法维持直径≥14毫米。构建多变量逻辑回归模型以预测RBES。
在128例确定的初次EGD和食管扩张患者中，25例符合RBES标准。从自我扩张队列中又确定了63例RBES患者，共有88例RBES患者和103例非RBES患者。多变量分析产生了一个强大的预测模型，c统计量为0.85，确定狭窄长度≥2厘米、直径≤7毫米以及近端或弥漫性狭窄部位与RBES风险较高相关。没有任何这些风险因素的患者发生RBES的风险为2%，而具有所有3个风险因素的患者发生RBES的风险为73%。
基于狭窄特征，在初次EGD时可预测RBES的风险。基于易于获得的风险因素创建了一个RBES预测模型，这可能指导对良性食管狭窄患者采取个体化治疗方法，潜在地降低发病率和费用。
