3D IMPEDANCE PLANIMETRY IMPROVES PERI-INTERVENTIONAL PROCEDURE IN ENDOSCOPIC THERAPY OF COMPLEX ESOPHAGEAL STENOSIS

Aims Non-malignant strictures in the upper GI tract causing dysphagia have significant impact on QoL in patients. Esophageal dilation using fluoroscopic control is standard. Especially complex stenosis challenge the interventional endoscopist regarding size and tissue compliance. Tools to evaluate exact stenosis configuration without additional X-ray exposure are mandatory. 3D-planimetry could offer the possibility to estimate exact size, diameter and tissue resistance.

Methods A prospective, interventional study was conducted at our endoscopy unit. Patients with complex benign stenosis and clinical symptoms were included. 3D-planimetry supported measurement was performed prior and after bougienage. Primary endpoint was success of endoscopic dilation. Success was defined as sufficient dilation of the stenosis in one endoscopic session with endoscopic passage possible after bougienage. Objectifiable differences were analyzed by 3D-planimetry.

Results 26 patients (m/f, 11/14) participated, mean age was 49.5 years (±23.2) (range 21-82). Etiology of strictures was peptic (n=2), radiation (n=10), anastomosis (n=5), caustic ingestion (n=7) or EoE (n=2). Median diameter of strictures before treatment was 6.8mm(±2.1) and 8.7mm(±2.6) after, median length 23.4mm(±16.5). Successful dilatation was possible in 96.1%(n=25). No severe complications or adverse events were reported. Length of respective stenosis was underestimated by endoscopist in comparison to 3D-supported measurement (p=0.016). Analysis of diameter of stenosis (p=0.014) and CSA (p=0.037) revealed an objectifiable impact by dilation procedure.

Conclusions Periinterventional measurement by 3D-planimetry enables as well direct visual control of stenosis configuration as documentation of postinterventional dilation effect. This might help to adapt more precisely to the stricture, avoiding additional radiation exposure in endoscopic treatment.

Publication History

Article published online:
14 April 2022