Chobarporn Thitiporn, Mesiri Dudsadee, Tharavej Chadin
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
Surg Endosc. 2025 May 30. doi: 10.1007/s00464-025-11820-3.
Caustic esophageal stricture is usually refractory to endoscopic dilation. A stepwise endoscopic intervention using various modalities has been recommended, with surgery reserved as a last resort. However, the outcomes of stepwise treatment and the impact of prolonged prior endoscopic interventions on subsequent esophageal reconstruction in caustic refractory benign esophageal stricture (cRBES) are not well understood. This study aims to investigate the long-term outcomes of stepwise endoscopic and surgical treatments for this condition.
Patients diagnosed with cRBES were included. Stepwise endoscopic interventions, including intralesional steroid injections combined with dilations and esophageal stent insertion, were sequentially performed as the initial treatment. Esophageal reconstruction is offered to patients who experience failed sequential endoscopic therapies.
Of the 252 patients with a history of corrosive ingestion, forty-one met the criteria for cRBES. Intralesional steroid injections with dilations and stent insertions were primarily performed. Among the 41 patients, 8 (20%) were successfully treated with endoscopic therapy. The success rate of endoscopic treatment was significantly higher for patients with the recurrent subtype compared to those with the refractory subtype (8/11 vs. 0/30, p < 0.0001). Of these 41 patients, 33 (80%) underwent esophageal reconstruction at a median of 16 months after ingestion. There was one (3%) operative mortality. The prevalence of anastomotic leakage was 10%, and stricture was 12%. At a median follow-up of 32 months, nutritional autonomy was achieved in 91% following reconstruction.
One-fifth of patients with cRBES can be successfully treated with endoscopic interventions. However, 80% of these patients require subsequent esophageal reconstruction. This procedure is safe and effective, achieving favorable long-term outcomes in over 90% of patients who have previously failed various modalities of endoscopic treatments for cRBES. Early surgery should be considered for patients with the refractory subtype, while a stepwise approach can be applied to individuals with the recurrent subclassification.
腐蚀性食管狭窄通常难以通过内镜扩张治疗。已推荐采用多种方式的逐步内镜干预，手术则作为最后手段。然而，对于腐蚀性难治性良性食管狭窄（cRBES），逐步治疗的效果以及长期先行内镜干预对后续食管重建的影响尚不清楚。本研究旨在探讨针对这种情况的逐步内镜和手术治疗的长期效果。
纳入诊断为cRBES的患者。作为初始治疗，依次进行逐步内镜干预，包括病灶内注射类固醇联合扩张和食管支架置入。对于序贯内镜治疗失败的患者，提供食管重建。
在252例有腐蚀性物质摄入史的患者中，41例符合cRBES标准。主要进行了病灶内注射类固醇联合扩张及支架置入。在这41例患者中，8例（20%）通过内镜治疗成功治愈。复发亚型患者的内镜治疗成功率显著高于难治亚型患者（8/11 vs. 0/30，p < 0.0001）。在这41例患者中，33例（80%）在摄入后中位16个月时接受了食管重建。有1例（3%）手术死亡。吻合口漏的发生率为10%，狭窄为12%。中位随访32个月时，重建后91%的患者实现了营养自主。
五分之一的cRBES患者可通过内镜干预成功治疗。然而，这些患者中有80%需要后续食管重建。该手术安全有效，在先前各种内镜治疗方式均失败的cRBES患者中，超过90%的患者取得了良好的长期效果。对于难治亚型患者应考虑早期手术，而对于复发亚型患者可采用逐步治疗方法。
