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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1371-E1378
DOI: 10.1055/a-1223-1377
Original article

Can high-frequency mini-probe endoscopic ultrasonography predict outcome of endoscopic dilation in patients with benign esophageal strictures?

Philip Daniel‡
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Jayanta Samanta‡
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Ajay Gulati
2   Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Pankaj Gupta
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Gaurav Muktesh
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Saroj K. Sinha
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Rakesh Kochhar
1   Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background and study aims Endoscopic dilation is first-line management for benign esophageal strictures (ES). Depth of involvement of the esophageal wall on endosonography using high frequency mini-probe (EUS-M) may predict response to dilation. This study evaluated EUS-M characteristics to predict response of ES to endoscopic dilation.

Patients and methods EUS-M was used to measure the total esophageal wall thickness (EWT), involved EWT, percentage of involved wall and layers of wall involved in consecutive patients of benign ES. After a maximum of five sessions of endoscopic dilation, the cohort was divided into responders and refractory strictures. EUS-M characteristics were compared for underlying etiology as also between responders and refractory strictures.

Results Of the 30 strictures (17 females, age: 47.16 ± 15.86 yrs.) 13 were anastomotic, eight corrosive, seven peptic and 2 others. Corrosive strictures had the highest involved EWT and percentage of involved wall (3.51 ± 1.36 mm; 76.38 %) followed by anastomotic (2.73 ± 1.7 mm; 65.54 %) and peptic (1.39 ± 0.62 mm; 40.71 %) (P = 0.026 and 0.021 respectively). After five dilations, 22 were classified as responders and eight as refractory. Wall involvement > 70 % had a greater proportion of refractory strictures (P = 0.019). Strictures with involved EWT of ≥ 2.85 mm required more dilations (P = 0.011). Fewer dilations were required for stricture resolution with only mucosal involvement compared to deeper involvement such as submucosa and muscularis propria (2.14 vs. 5.80; P = 0.001).

Conclusion EUS-M evaluation shows that corrosive and anastomotic strictures have greater depth of involvement compared to peptic strictures. Depth of esophageal wall involvement in a stricture predicts response to dilation.



Publication History

Received: 26 February 2020

Accepted: 08 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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