Reply to Dong et al.

On behalf of all co-authors, we would like to thank Professor Fan and his colleagues for their thoughtful comments regarding our paper. In the following, these comments will be briefly addressed.

First, Fan et al. correctly point out that biodegradable stents were effective in reducing the number of dilations in the first 3 months, but overall endoscopic procedures were not decreased over this period compared with the dilation group [1]. This was mainly due to the fact that, in the first 3 months, some patients experienced retrosternal pain and food bolus obstruction. Regarding the latter, patients receiving a stent should be instructed that, although patency is established, it is important to follow an adapted diet (i. e. eating slowly, chewing thoroughly, and drinking fluids during the meal) to prevent obstruction. Regarding retrosternal pain, this has been reported with different types of stents, particularly in the first few days or week, after which it usually diminishes or disappears [2]. In our institution, we inform patients before stent placement about this possible adverse event and send them home with easily accessible analgesic medication. Moreover, we only perform diagnostic endoscopy when the pain persists for a longer period despite medication. However, in this multicenter study, some centers had a policy of performing diagnostic endoscopy at an earlier stage.

Second, anastomotic strictures were the main etiology of recurrent strictures in this study. Indeed, some other etiologies are increasingly seen in Asia, especially following (extensive) endoscopic resection and caustic strictures. Both types of strictures were also seen in our study [1], showing that the overall treatment approach when these strictures become refractory is similar for different etiologies. We expect that in the future, owing to the increasing number of endoscopic resections performed, (refractory) strictures due to this etiology will also be seen more often in the West.

Finally, like Fan et al., we agree that more studies are required to study the appropriate use of both biodegradable and fully covered metal stents for difficult strictures.

• References

• 1 Walter D, van den Berg MW, Hirdes MM. et al. Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial. Endoscopy 2018; 50: 1146-1155
• 2 Vermeulen BD, Siersema PD. Esophageal stenting in clinical practice: an overview. Curr Treat Options Gastroenterol 2018; 16: 260-273