Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center.
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
04
04
2021
accepted:
13
10
2021
pubmed:
6
7
2022
medline:
19
7
2022
entrez:
5
7
2022
Statut:
ppublish
Résumé
Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied. All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery. During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases. Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.
Sections du résumé
BACKGROUND
Predictors of the efficacy of endoscopic dilation for caustic esophageal stricture have been poorly studied.
METHODS
All patients undergoing an endoscopic dilation for an esophageal caustic stricture between 1990 and 2015 in a French national reference center were included. Success of dilation was defined by self-food autonomy without the need for reconstructive esophageal surgery.
RESULTS
During the study period, 894 patients were admitted after caustic ingestion. Among them, 101 patients developed esophageal stricture and 92 patients were eligible for analysis (missing data in 8 cases, 1 patient died before endoscopic dilation). In this cohort (median age 42 years, women 53%, strong alkali 74%, suicide attempt 77%, hydrostatic balloon use 93%), the overall success rate of dilation was 57% with a median number of 3 dilation sessions (274 sessions, range 1-17). Factors predicting the success of the procedure were: non-inflammatory stricture or non-inflammatory intercalated mucosa between stricture (88% vs 47%, p = 0.001), a single stricture versus 2 or more strictures (69% vs 47% vs 33%, respectively, p = 0.04), a stricture of less than 5 cm (70% vs 27%, p < 0.001) and the existence of mild/ moderately tight or very tight stricture (70% vs 21% of success, p < 0.001). Perforation rate was 6.5% (18/274) requiring emergency surgery in 2 cases.
CONCLUSION
Several characteristics of caustic esophageal strictures are significantly associated with the success rate of endoscopic dilation. Our data may be useful for customizing treatment strategies in patients with a caustic stricture.
Identifiants
pubmed: 35790591
doi: 10.1007/s00464-021-08781-8
pii: 10.1007/s00464-021-08781-8
doi:
Substances chimiques
Caustics
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5660-5668Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Hugh TB, Kelly MD (1999) Corrosive ingestion and the surgeon. J Am Coll Surg 189:508–522
doi: 10.1016/S1072-7515(99)00160-X
Chang JM, Liu NJ, Pai BC et al (2011) The role of age in predicting the outcome of caustic ingestion in adults: a retrospective analysis. BMC Gastroenterol 11:72
doi: 10.1186/1471-230X-11-72
Contini S, Scarpignato C (2013) Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 19:3918–3930
doi: 10.3748/wjg.v19.i25.3918
Chirica M, Kelly MD, Sarfati E, Cattan P (2017) Caustic ingestion. Lancet 389:2041–2052
doi: 10.1016/S0140-6736(16)30313-0
Broor SL, Raju GS, Bose PP et al (1993) Long term results of endoscopic dilation for corrosive oesophageal strictures. Gut 34(11):1498–1501
doi: 10.1136/gut.34.11.1498
Piotet E, Escher A, Monnier P (2008) Esophageal and pharyngeal strictures: report on 1862 endoscopic dilations using the Savary-Gilliard technique. Eur Arch Oto-Rhino-Laryngol 265:357–364
doi: 10.1007/s00405-007-0456-0
Rodrigues-Pinto E, Pereira P, Ribeiro A et al (2016) Risk factors associated with refractoriness to esophageal dilation for benign dysphagia. Eur J Gastroenterol Hepatol 28:684–688
doi: 10.1097/MEG.0000000000000594
Vermeulen B, de Zwart M, Sijben J et al (2020) Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study. Gastrointest Endosc 91(5):1058–1066
doi: 10.1016/j.gie.2019.12.040
Pereira-Lima JC, Ramires RP, Zamin I Jr et al (1999) Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 94(6):1497–1501
doi: 10.1111/j.1572-0241.1999.01061.x
Chirica M, Resche-Rigon M, Pariente B et al (2015) Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy. Surg Endosc 29:1452–1461
doi: 10.1007/s00464-014-3823-0
Chirica MR, Zagdanski AM, Bruzzi M et al (2016) Computed tomography evaluation of esophagogastric necrosis after caustic ingestion. Ann Surg 264:107–113
doi: 10.1097/SLA.0000000000001459
Bruzzi M, Chirica M, Resche-Rigon M et al (2019) Emergency computed tomography predicts caustic esophageal stricture formation. Ann Surg 270(1):109–114
doi: 10.1097/SLA.0000000000002732
Tseng YL, Wu MH, Lin MY et al (2004) Massive upper gastrointestinal bleeding after acid-corrosive injury. World J Surg 28:50–54
doi: 10.1007/s00268-003-6831-0
Chirica M, Veyrie N, Munoz-Bongrand N et al (2010) Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg 252:271–280
doi: 10.1097/SLA.0b013e3181e8fd40
Zargar SA, Kochhar R, Mehta S et al (1991) The role of fibe-roptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 37:165–169
doi: 10.1016/S0016-5107(91)70678-0
Broor SL, Raju GS, Bose PP et al (1993) Long term results of endoscopic dilation for corrosive oesophageal strictures. Gut 34:1498–1501
doi: 10.1136/gut.34.11.1498
Chiu YC, Liang CM, Tam W et al (2013) The effects of endoscopic-guided balloon dilations in esophageal and gastric strictures caused by corrosive injuries. BMC Gastroenterol 13:99
doi: 10.1186/1471-230X-13-99
Zhang C, Zhou X, Yu L et al (2013) Endoscopic therapy in the treatment of caustic esophageal stricture: a retrospective case series study. Dig Endosc 25(5):490
doi: 10.1111/den.12023
Josino IR, Madruga-Neto AC, Ribeiro IB et al (2018) Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. Gastroenterol Res Pract. https://doi.org/10.1155/2018/5874870
doi: 10.1155/2018/5874870
pubmed: 30116265
pmcid: 6079446
Poincloux L, Rouquette O, Abergel A (2017) Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol 11(1):53–64
doi: 10.1080/17474124.2017.1260002
El-Asmar KM, Allam AM (2020) Predictors of successful endoscopic management of caustic esophageal strictures in children: when to stop the dilations? J Pediatr Surg S0022–3468(20):30595–30599
Chirica M, Champault A, Dray X et al (2010) Esophageal perforations. J Visc Sirg 147(3):e117–e128
doi: 10.1016/j.jviscsurg.2010.08.003
Hauge T, Kleven OC, Johnson E et al (2019) Outcome after iatrogenic esophageal perforation. Scand J Gastroenterol 54(2):140–144
doi: 10.1080/00365521.2019.1575464
Wesdorp IC, Bartelsman JF, Huibregtse K et al (1984) Treatment of instrumental oesophageal perforation. Gut 25(4):398–404
doi: 10.1136/gut.25.4.398
Everett SM (2019) Endoscopic management of refractory benign oesophageal strictures. Ther Adv Gastrointest Endosc 12:2631774519862134
pubmed: 31460518
pmcid: 6702770
Kochhar R, Samanta J, Basha J et al (2017) Biodegradable stents for caustic esophageal strictures: do they work? Dysphagia 32(4):575–582
doi: 10.1007/s00455-017-9800-8
El-Asmar KM, Hassan MA, Abdelkader HM et al (2013) Topical mitomycin C application is effective in management of localized caustic esophageal stricture: a double-blinded, randomized, placebo-controlled trial. J Pediatr Surg 48(7):1621–1627
doi: 10.1016/j.jpedsurg.2013.04.014
Corte H, Assistance Publique Hôpitaux de Paris, Corticosteroid Treatment in the Acute Phase of Caustic Ingestion Management (CORTICAU). NCT03760354
Poghosyan T, Catry J, Luong-Nguyen M et al (2016) Esophageal tissue engineering: current status and perspectives. J Visc Surg 153(1):21–29
doi: 10.1016/j.jviscsurg.2015.11.009
Zhang X, Wang M, Han H et al (2012) Corrosive induced carcinoma of esophagus after 58 years. Ann Thorac Surg 94:2103–2105
doi: 10.1016/j.athoracsur.2012.03.110
Pennachi C, Hourneaux de Moura DT, Amorim R et al (2017) Lugol’s iodine chromoendoscopy versus narrow band image enhanced endoscopy for the detection of esophageal cancer in patients with stricture secondary to caustic/corrosive agent ingestion. Arq Gastroenterol 54(3):250–254
doi: 10.1590/s0004-2803.201700000-19
Eckardt VF, Aignherr C, Bernhard G (1992) Predictors of out-come in patients with achalasia treated by pneumatic dilation. Gastroenterology 103:1732–1738
doi: 10.1016/0016-5085(92)91428-7