Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study
| Autor: | Merle de Zwart, Daan W. von den Hoff, Adriaan C.I.T.L. Tan, Auke Bogte, Manon C.W. Spaander, Peter D. Siersema, Elsa Soons, Bram D. Vermeulen, Lucie van der Weerd, M. J.M. Groenen, Vincenzo Craviotto, Alessandro Repici, Jasmijn Sijben, Daniele Arese |
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| Přispěvatelé: | Gastroenterology & Hepatology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Peptic Anastomosis 03 medical and health sciences Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] 0302 clinical medicine All institutes and research themes of the Radboud University Medical Center Interquartile range Risk Factors Internal medicine medicine Clinical endpoint Humans Radiology Nuclear Medicine and imaging Adverse effect Netherlands Retrospective Studies business.industry Medical record Hazard ratio Gastroenterology Retrospective cohort study Dilatation Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] Treatment Outcome 030220 oncology & carcinogenesis Esophageal Stenosis 030211 gastroenterology & hepatology business Follow-Up Studies |
| Zdroj: | Gastrointestinal Endoscopy, 91(5), 1058-1066. Mosby Inc. Gastrointestinal Endoscopy, 91, 5, pp. 1058-1066 Gastrointestinal Endoscopy, 91, 1058-1066 |
| ISSN: | 0016-5107 |
| Popis: | Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BESs). This study aimed to establish risk factors for refractory BESs and assess long-term clinical outcomes of ED.We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BESs. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BESs, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints were time from first to last ED session and adverse events.Dilation up to 13 to 15 mm was associated with a higher number of ED sessions than dilation up to 16 to 18 mm (5.0 vs 4.1; hazard ratio [HR], 1.4; P = .001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR, 2.1; P .001), radiation (5.0 vs 3.6; HR, 3.0; P .001), caustic (7.2 vs 3.6; HR, 2.7; P .001), and postendotherapy (3.9 vs 3.6; HR, 1.8; P = .005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy, and 62% in caustic strictures. Esophageal perforation occurred in 23 ED sessions (.4%) in 22 patients (2.4%).More than 60% of patients with BESs remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18 mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16 mm to reduce the number of ED sessions in these patients. |
| Databáze: | OpenAIRE |
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