Early stepping up of selected patients with non malignant esophageal stricture from Wire Guided bougie dilatation to Endoscopic needle knife incisions

Aims Non malignant esophagial stricture(NMES) are usually treated by esophageal dilatation, but many are refractory to therapy. According to the local experience in Misurata Centre of Gastroenterology and Hepatology (MCGH), patients with endoscopic visible local circumferential fibrous tissue (esophageal webs, fibrotic bands or short segments of fibrotic stricture) are more refractory to Wire guided bouge dilitation (WGBD). Therefore, this study aims to test the safety and effectiveness of early stepping up of selected patients with Non malignant esophagial stricture to Endoscopic needle knife incision (ENKI).

Methods This is a single centre prospective interventional study carried out in MCGH over two-year period (from the 1st of February 2022 till the 31st of January 2024). All patients with NMES were assessed with barium swallow and those who needed intervention were included and received WGBD sessions to reach satisfactory improvement (passage of 12mm wire guided boogie dilator plus post dilatation symptom improvement) in one or multiple sessions two weeks apart. However, those who has localized fibrotic tissue were treated with no more than two WGBD sessions and if satisfactory dilatation was not reached, they go directly for ENKI. Incisions were directed to more than one angle (12, and 6 o’clock plus 3 or 9 o’clock). All patients were followed up for 6 months’ post therapy. Patients’ personal data, cause of stricture, response to therapy and incidence of complications were recorded and presented [1] [2] [3] [4] [5].

Results 19 patients presented to MCGH with NMES requiring intervention (11 peptic stricture, 4 post radiotherapy, 2 post corrosive ingestion, 1 bullous pemphigoid and 1 plummer vinson syndrome). All patients were treated with WGBD sessions to satisfactory improvement. Success rate was approximately 74% at the second session (14 out of 19 patients). However, The remaining 5 patients (2 post corrosive ingestion. 2 post radiotherapy and 1 plummer venson syndrome) were stepped up for ENKI two weeks after the second WGBD. All of those five patients improved from the first ENKI attempt. One patient from those who received ENKI (post corrosive ingestion stricture) suffered residual dysphagia within the follow up period and improved after one additional session of WGBD. No incidence of bleeding or perforation was reported.

Conclusions Early stepping up of selected patients with NMES to ENKI post the second faliure WGBD session was safe and effective in reaching satisfactory improvement without the need for further WGBD. Further studies are needed to draw out guidelines to facilitate practice.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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