Original articleClinical endoscopyNatural history and management of refractory benign esophageal strictures
Section snippets
Patients and data collection
Clinical charts of patients who were managed over the previous 15 years in 2 tertiary-care referral academic centers (Humanitas Research Hospital, Milan, Italy, and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA) were retrospectively reviewed, and patients who had a diagnosis of refractory or recurrent esophageal strictures, defined as the persistence or recurrence of dysphagia despite at least 5 endoscopic treatment sessions, were selected. Data were retrieved from
Study population
Overall, 70 patients were identified and included for analysis (46 male; median age at diagnosis 60 years, range 23-81 years). Nineteen and 51 patients were managed at the Humanitas Research Hospital and the Hospital of the University of Pennsylvania, respectively. Esophageal strictures were caused by caustic injury in 7 patients (10%), radiation therapy in 10 (14.3%), surgery in 22 (31.4%), a mixture of these etiologies in 28 (40%), and by fibrosis related to previous inflammatory processes in
Discussion
We have shown that the long-term outcome of endoscopic treatment for RBES is unfavorable, with less than one-third of the patients achieving resolution of dysphagia, and the majority still requiring continuous endoscopic dilation at the end of follow-up. The addition of endoprosthetic placement to dilation therapy did not significantly affect the long-term outcome of patients with RBES.
The findings of our study are relevant for several reasons. First, we restricted our cohort only to patients
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2020, Gastrointestinal EndoscopyCitation Excerpt :In 2005, Kochman et al20 proposed a refractory BES definition to achieve uniformity among clinical studies. Since then, this definition has only been used in 1 study that investigated risk factors for refractory BES6 but not in other studies.7,21 Second, the varying results may also be related to the relatively small sample size of previous studies (range, 63-87 patients), which may have resulted in poor adjustment for confounding (eg, type of BES) in the multivariate analysis.6-8
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
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See CME section; p. 329.