Retrograde endoscopic dilatation for difficult caustic esophageal strictures: Feasibility and effectiveness
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Read the article on jpedsurg.org ↗Article · Feb 2019 · 1 min read
In brief
In brief
Retrospective study of 22 patients with difficult caustic esophageal strictures demonstrates that retrograde endoscopic dilatation achieved success in 82% of cases where antegrade approach failed. This technique preserved native esophagus in 57% of retrograde-dilated patients, offering a valuable alternative before esophageal replacement surgery.
Written by the GCMD Library team from the article.
Background
Difficult caustic esophageal strictures may need a more sophisticated dilatation technique before referring for esophageal replacement surgery.
Patients & method
Retrospective review of caustic esophageal strictures managed at our center between January 2010 and June 2018 was done. Twenty two patients labeled as undilatable strictures were enrolled. These patients had another trial for endoscopic dilatation using retrograde approach.
Results
Among these 22 patients, 5 patients could be dilated by antegrade approach. Seventeen patients had a trial of retrograde dilatation after failed antegrade endoscopy. Retrograde dilatation was successful in 14 patients (82%). Nasogastric tube was left following dilatation in 4 patients to facilitate next sessions. Collectively, 19 out of the 22 patients could have their esophagus dilated in the first instance (86%). Among retrograde dilated patients; eight patients succeeded to retain their native esophagus (57%), two patients are still on dilatation with marked improvement (14%), and three patients underwent colon interposition owing to refractory stricture despite frequent dilatations.
Conclusion
Every attempt should be tried to preserve the native esophagus. Retrograde endoscopic dilatation is a valuable alternative for undilatable stricture before referring the patient for replacement surgery.
Level of evidence
This is a case series with no comparison group (level IV).