Leiden University Scholarly Publications

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Halsema, E.E. van; Bergman, J.J.G.H.M.; Sandick, J.W. van; Henegouwen, M.I.V.; Cats, A.; Veenhof, A.A.F.A.; ... ; Dieren, J.M. van (2022)

Intensive endoscopic therapy for untreated cervical anastomotic strictures after esophagectomy: a pilot study

Article / Letter to editor
Background: Cervical anastomotic strictures after esophagectomy cause significant disease burden. We aimed to study the technical feasibility and safety of intensive endoscopic therapy. Methods: In this pilot study, we included 15 patients with an untreated benign cervical anastomotic stricture after esophagectomy. Intensive endoscopic therapy comprised three endoscopic modalities: in- and excision using a needle-knife, intralesional steroid injections and bougie dilation. In two endoscopic procedures, the stricture was dilated up to a luminal diameter of 18 mm. Patients were followed up to 6 months. Results: A luminal diameter of 18 mm was achieved in 13 of 15 patients (87%) after two endoscopic procedures. No major adverse events related to the investigational treatment occurred. Median dysphagia scores significantly improved from 2 (IQR, interquartile range, 2-3) at baseline to 0 (IQR 0-1) after 14 days (p < 0.001). Eleven (73%) patients developed recurrent symptoms of...Show moreBackground: Cervical anastomotic strictures after esophagectomy cause significant disease burden. We aimed to study the technical feasibility and safety of intensive endoscopic therapy. Methods: In this pilot study, we included 15 patients with an untreated benign cervical anastomotic stricture after esophagectomy. Intensive endoscopic therapy comprised three endoscopic modalities: in- and excision using a needle-knife, intralesional steroid injections and bougie dilation. In two endoscopic procedures, the stricture was dilated up to a luminal diameter of 18 mm. Patients were followed up to 6 months. Results: A luminal diameter of 18 mm was achieved in 13 of 15 patients (87%) after two endoscopic procedures. No major adverse events related to the investigational treatment occurred. Median dysphagia scores significantly improved from 2 (IQR, interquartile range, 2-3) at baseline to 0 (IQR 0-1) after 14 days (p < 0.001). Eleven (73%) patients developed recurrent symptoms of dysphagia requiring a median of 1 (IQR 0-3) additional endoscopic dilation procedure. Conclusions: Achieving a luminal diameter of 18 mm in two procedures with intensive endoscopic therapy was technically feasible and effective in reducing dysphagia rapidly in patients with a cervical anastomotic stricture after esophagectomy. No major adverse events related to the investigational treatment were observed.Show less
Benign esophageal strictures
Endoscopic dilation
Esophagus
Endoscopic therapy
Esophagectomy
Anastomosis
All authors
Halsema, E.E. van; Bergman, J.J.G.H.M.; Sandick, J.W. van; Henegouwen, M.I.V.; Cats, A.; Veenhof, A.A.F.A.; Hooft, J.E. van; Dieren, J.M. van
Date
2022-10-25
Journal
Surgical Endoscopy
Volume
37
Pages
2029 - 2034
DOI
doi:10.1007/s00464-022-09731-8