Predictive factors for the success of endoscopic dilation of esophageal caustic stricture: the experience of a French tertiary reference center.

Autor: Hammoudi N; Gastroenterology Department, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France., Giaoui A; Gastroenterology Department, Hôpital Saint-Camille, Bry Sur Marne, France., Lambert J; Biostatistics Department, Hôpital Saint-Louis, Paris, France., Dhooge M; Gastroenterology Department, Hôpital Cochin, Paris, France., Corte H; Digestive Surgery Department, Hôpital Saint-Louis, Paris, France., Tran-Minh ML; Gastroenterology Department, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France., Cattan P; Digestive Surgery Department, Hôpital Saint-Louis, Paris, France., Gornet JM; Gastroenterology Department, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. jean-marc.gornet@aphp.fr.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Aug; Vol. 36 (8), pp. 5660-5668. Date of Electronic Publication: 2022 Jul 05.
DOI: 10.1007/s00464-021-08781-8
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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