Esophageal stricture surgery: Difference between revisions

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==Overview==
==Overview==
The mainstay of treatment for [[esophageal stricture]] is medical therapy and dilation. Self-expandable plastic or metal [[Stent|stents]] placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of [[dysphagia]], extraesophageal manifestations and long term [[side effects]] of medical therapy
The mainstay of treatment for [[esophageal stricture]] is [[dilation]]. [[Proton pump inhibitor|Proton pump inhibitors]] or [[Histamine-2 receptor blocker|H2 antagonists]] are recommended among all patients  who develop [[esophageal]] [[stricture]] due to [[gastroesophageal reflux disease]]. Self-expandable plastic or metal [[Stent|stents]] placement is indicated for patients with refractory [[esophageal]] [[stricture]]. [[Surgery]] is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of [[dysphagia]], extraesophageal manifestations and long term [[side effects]] of medical therapy


==Surgery==
==Surgery==
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The most common cause of esophageal stricture is [[gastroesophageal reflux disease]]. Treatment for esophageal stricture is combination of dilation and  [[Proton pump inhibitor|proton pump inhibitors]]  or H2 antagonist therapy.<ref name="pmid7926495">{{cite journal |vauthors=Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A |title=A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group |journal=Gastroenterology |volume=107 |issue=5 |pages=1312–8 |year=1994 |pmid=7926495 |doi= |url=}}</ref>
* Cautious dilation <ref name="pmid15625037">{{cite journal |vauthors=Nostrant TT |title=Esophageal Dilation / Dilators |journal=Curr Treat Options Gastroenterol |volume=8 |issue=1 |pages=85–95 |year=2005 |pmid=15625037 |doi= |url=}}</ref>
** [[Caustic (substance)|Caustic]] strictures
** [[Radiation]] stricture
** Eosinophilic esophagitis  due to increased risk of perforation
** [[Bleeding disorders]]
** Severe [[cardiovascular]] disease or [[pulmonary]] disease
* Dilators<ref name="pmid15625037" /> <ref name="pmid2382455">{{cite journal |vauthors=Shemesh E, Czerniak A |title=Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures |journal=World J Surg |volume=14 |issue=4 |pages=518–21; discussion 521–2 |year=1990 |pmid=2382455 |doi= |url=}}</ref><ref name="pmid7818628">{{cite journal |vauthors=Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR |title=Balloon or bougie for dilatation of benign esophageal stricture? |journal=Dig. Dis. Sci. |volume=39 |issue=4 |pages=776–81 |year=1994 |pmid=7818628 |doi= |url=}}</ref>     
** Mechanical ( bougie) that can be done with 
*** Guidewire such as savary-gilliard and eder-puestow olive dilators
*** Nonguidewire such as maloney and hurst dilator 
** Balloon dilators
* Self-expandable plastic or metal [[stent]]<nowiki/>s placement for patients with refractory esophageal stricture  <ref name="pmid14716840">{{cite journal |vauthors=Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ |title=Complications of stent placement for benign stricture of gastrointestinal tract |journal=World J. Gastroenterol. |volume=10 |issue=2 |pages=284–6 |year=2004 |pmid=14716840 |pmc=4717021 |doi= |url=}}</ref><ref name="pmid15472671">{{cite journal |vauthors=Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G |title=Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures |journal=Gastrointest. Endosc. |volume=60 |issue=4 |pages=513–9 |year=2004 |pmid=15472671 |doi= |url=}}</ref>
* Self dilation at home  with bougie dilators <ref name="pmid23925823">{{cite journal |vauthors=Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA |title=Self-dilation as a treatment for resistant, benign esophageal strictures |journal=Dig. Dis. Sci. |volume=58 |issue=11 |pages=3218–23 |year=2013 |pmid=23925823 |doi=10.1007/s10620-013-2822-7 |url=}}</ref>
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* local [[steroid]] injection in refractory strictures by inhibiting [[collagen]] formation <ref name="pmid19439958">{{cite journal |vauthors=Pregun I, Hritz I, Tulassay Z, Herszényi L |title=Peptic esophageal stricture: medical treatment |journal=Dig Dis |volume=27 |issue=1 |pages=31–7 |year=2009 |pmid=19439958 |doi=10.1159/000210101 |url=}}</ref>
* Pharyngoesophageal puncture in severe upper esophageal [[stenosis]] after [[radiation therapy]] for [[laryngeal]] and [[Hypopharyngeal cancer|hypopharyngeal cancers]]  <ref name="pmid19517185">{{cite journal |vauthors=Tang SJ, Singh S, Truelson JM |title=Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos) |journal=Surg Endosc |volume=24 |issue=1 |pages=210–4 |year=2010 |pmid=19517185 |doi=10.1007/s00464-009-0535-y |url=}}</ref>
* [[Brachytherapy]] is recommended among patients with '''[[malignant]]''' esophageal stricture with a life expectancy more than three months.<ref name="pmid22534713">{{cite journal |vauthors=Kujawski K, Stasiak M, Rysz J |title=The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer |journal=Med. Sci. Monit. |volume=18 |issue=5 |pages=CR323–9 |year=2012 |pmid=22534713 |pmc=3560635 |doi= |url=}}</ref>
*  [[Stent]] placement for [[malignant]] esophageal stricture as a [[palliative therapy]] with expected survival time less than three months<ref name="pmid22534713" /><ref name="pmid18250638">{{cite journal |vauthors=Siersema PD |title=Treatment options for esophageal strictures |journal=Nat Clin Pract Gastroenterol Hepatol |volume=5 |issue=3 |pages=142–52 |year=2008 |pmid=18250638 |doi=10.1038/ncpgasthep1053 |url=}}</ref>
*[[Feeding tube]] and [[gastrostomy]] for patients that  are not good candidate for [[surgery]] <ref name="pmid26542798">{{cite journal |vauthors=Yang CW, Lin HH, Hsieh TY, Chang WK |title=Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study |journal=BMC Palliat Care |volume=14 |issue= |pages=58 |year=2015 |pmid=26542798 |pmc=4635529 |doi=10.1186/s12904-015-0056-5 |url=}}</ref>


*Esophageal surgical [[resection]] via colonic interposition between cervical [[esophagus]] and [[duodenum]] or [[stomach]] <ref name="pmid1483661">{{cite journal |vauthors=Csendes A, Braghetto I |title=Surgical management of esophageal strictures |journal=Hepatogastroenterology |volume=39 |issue=6 |pages=502–10 |year=1992 |pmid=1483661 |doi= |url=}}</ref
[[Surgery]] is not the [[first-line treatment]] option for patients with [[esophageal]] [[stricture]] because it can lead to serious morbidity and mortality. <ref name="pmid21346853">{{cite journal |vauthors=Baron TH |title=Management of benign esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=1 |pages=46–9 |year=2011 |pmid=21346853 |pmc=3038317 |doi= |url=}}</ref>
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[[Surgery]] is usually reserved for patients with either:<ref name=":0">{{cite book | last = Holzheimer | first = R | title = Surgical treatment : evidence-based and problem-oriented | publisher = Zuckschwerdt | location = München New York | year = 2001 | isbn = 3-88603-714-2 }}</ref>
* Inability to [[dilate]] the [[stricture]]
* Frequent recurrence of [[dysphagia]]
* [[Esophagitis]] refractory to medical therapy
* Extraesophageal manifestations such as [[aspiration pneumonia]]
* Long term [[side effects]] of medical therapy in young patients.


Some methods of [[surgery]] are included:
* [[Laparoscopic]] [[esophagectomy]]<ref name=":0" />


==Indications for surgery ==
* Pharyngoesophageal puncture in severe upper [[esophageal]] [[stenosis]] after [[radiation therapy]] for [[laryngeal]] and [[Hypopharyngeal cancer|hypopharyngeal cancers]]<ref name="pmid19517185">{{cite journal |vauthors=Tang SJ, Singh S, Truelson JM |title=Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos) |journal=Surg Endosc |volume=24 |issue=1 |pages=210–4 |year=2010 |pmid=19517185 |doi=10.1007/s00464-009-0535-y |url=}}</ref>
* Inability to [[dilate]] the stricture
* Frequent recurrence of dysphagia
* [[Esophagitis]] refractory to medical therapy
* Extraesophageal manifestations such as [[aspiration pneumonia]]
* Long term side effects of medical therapy in young patients.  


*[[Esophageal]] surgical [[resection]] via colonic interposition between [[cervical]] [[esophagus]] and [[duodenum]] or [[stomach]] especially after [[caustic]] injury<ref name="pmid1483661">{{cite journal |vauthors=Csendes A, Braghetto I |title=Surgical management of esophageal strictures |journal=Hepatogastroenterology |volume=39 |issue=6 |pages=502–10 |year=1992 |pmid=1483661 |doi= |url=}}</ref><ref name="pmid15334683">{{cite journal |vauthors=Han Y, Cheng QS, Li XF, Wang XP |title=Surgical management of esophageal strictures after caustic burns: a 30 years of experience |journal=World J. Gastroenterol. |volume=10 |issue=19 |pages=2846–9 |year=2004 |pmid=15334683 |pmc=4572115 |doi= |url=}}</ref>


==References==
==References==
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Medicine]]
[[Category:Medicine]]
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[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Surgery]]

Latest revision as of 21:41, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

The mainstay of treatment for esophageal stricture is dilation. Proton pump inhibitors or H2 antagonists are recommended among all patients who develop esophageal stricture due to gastroesophageal reflux disease. Self-expandable plastic or metal stents placement is indicated for patients with refractory esophageal stricture. Surgery is usually reserved for patients with either inability to dilate the stricture, frequent recurrence of dysphagia, extraesophageal manifestations and long term side effects of medical therapy

Surgery

Surgery is not the first-line treatment option for patients with esophageal stricture because it can lead to serious morbidity and mortality. [1]

Surgery is usually reserved for patients with either:[2]

Some methods of surgery are included:

References

  1. Baron TH (2011). "Management of benign esophageal strictures". Gastroenterol Hepatol (N Y). 7 (1): 46–9. PMC 3038317. PMID 21346853.
  2. 2.0 2.1 Holzheimer, R (2001). Surgical treatment : evidence-based and problem-oriented. München New York: Zuckschwerdt. ISBN 3-88603-714-2.
  3. Tang SJ, Singh S, Truelson JM (2010). "Endotherapy for severe and complete pharyngo-esophageal post-radiation stenosis using wires, balloons and pharyngo-esophageal puncture (PEP) (with videos)". Surg Endosc. 24 (1): 210–4. doi:10.1007/s00464-009-0535-y. PMID 19517185.
  4. Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.
  5. Han Y, Cheng QS, Li XF, Wang XP (2004). "Surgical management of esophageal strictures after caustic burns: a 30 years of experience". World J. Gastroenterol. 10 (19): 2846–9. PMC 4572115. PMID 15334683.

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