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 | 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 | ||
==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 | 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> | * 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 strictures | ** [[Caustic (substance)|Caustic]] strictures | ||
** Radiation stricture | ** [[Radiation]] stricture | ||
** Eosinophilic esophagitis due to increased risk of perforation | ** Eosinophilic esophagitis due to increased risk of perforation | ||
** Bleeding disorders | ** [[Bleeding disorders]] | ||
** Severe cardiovascular disease or pulmonary disease | ** Severe [[cardiovascular]] disease or [[pulmonary]] disease | ||
* Dilators<ref name="pmid15625037" /> | * 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 | ** Mechanical ( bougie) that can be done with | ||
*** Guidewire such as savary-gilliard and eder-puestow olive dilators | *** Guidewire such as savary-gilliard and eder-puestow olive dilators | ||
*** Nonguidewire such as maloney and hurst dilator | *** Nonguidewire such as maloney and hurst dilator | ||
** Balloon dilators | ** Balloon dilators | ||
* Self-expandable plastic or metal | * 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> | * 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> | * 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 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> | * 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> | * [[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 | * [[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> | *[[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> | *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> | ||
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==Indications for surgery == | ==Indications for surgery == | ||
* Inability to dilate the stricture | * Inability to [[dilate]] the stricture | ||
* Frequent recurrence of dysphagia | * Frequent recurrence of dysphagia | ||
* Esophagitis refractory to medical therapy | * [[Esophagitis]] refractory to medical therapy | ||
* Extraesophageal manifestations such as aspiration pneumonia | * Extraesophageal manifestations such as [[aspiration pneumonia]] | ||
* Long term side effects of medical therapy in young patients. | * Long term side effects of medical therapy in young patients. | ||
Revision as of 16:51, 7 November 2017
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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 medical therapy and dilation. 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
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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 inhibitors or H2 antagonist therapy.[1]
- Cautious dilation [2]
- Caustic strictures
- Radiation stricture
- Eosinophilic esophagitis due to increased risk of perforation
- Bleeding disorders
- Severe cardiovascular disease or pulmonary disease
- Dilators[2] [3][4]
- 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
- Mechanical ( bougie) that can be done with
- Self-expandable plastic or metal stents placement for patients with refractory esophageal stricture [5][6]
- Self dilation at home with bougie dilators [7]
| FIRiPny4n6Y|500}} |
- local steroid injection in refractory strictures by inhibiting collagen formation [8]
- Pharyngoesophageal puncture in severe upper esophageal stenosis after radiation therapy for laryngeal and hypopharyngeal cancers [9]
- Brachytherapy is recommended among patients with malignant esophageal stricture with a life expectancy more than three months.[10]
- Stent placement for malignant esophageal stricture as a palliative therapy with expected survival time less than three months[10][11]
- feeding tube and gastrostomy for patients that are not good candidate for surgery [12]
- Esophageal surgical resection via colonic interposition between cervical esophagus and duodenum or stomach [13]
Indications for surgery
- 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.
References
- ↑ Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A (1994). "A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group". Gastroenterology. 107 (5): 1312–8. PMID 7926495.
- ↑ 2.0 2.1 Nostrant TT (2005). "Esophageal Dilation / Dilators". Curr Treat Options Gastroenterol. 8 (1): 85–95. PMID 15625037.
- ↑ Shemesh E, Czerniak A (1990). "Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures". World J Surg. 14 (4): 518–21, discussion 521–2. PMID 2382455.
- ↑ Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR (1994). "Balloon or bougie for dilatation of benign esophageal stricture?". Dig. Dis. Sci. 39 (4): 776–81. PMID 7818628.
- ↑ Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2004). "Complications of stent placement for benign stricture of gastrointestinal tract". World J. Gastroenterol. 10 (2): 284–6. PMC 4717021. PMID 14716840.
- ↑ Repici A, Conio M, De Angelis C, Battaglia E, Musso A, Pellicano R, Goss M, Venezia G, Rizzetto M, Saracco G (2004). "Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures". Gastrointest. Endosc. 60 (4): 513–9. PMID 15472671.
- ↑ Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA (2013). "Self-dilation as a treatment for resistant, benign esophageal strictures". Dig. Dis. Sci. 58 (11): 3218–23. doi:10.1007/s10620-013-2822-7. PMID 23925823.
- ↑ Pregun I, Hritz I, Tulassay Z, Herszényi L (2009). "Peptic esophageal stricture: medical treatment". Dig Dis. 27 (1): 31–7. doi:10.1159/000210101. PMID 19439958.
- ↑ 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.
- ↑ 10.0 10.1 Kujawski K, Stasiak M, Rysz J (2012). "The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer". Med. Sci. Monit. 18 (5): CR323–9. PMC 3560635. PMID 22534713.
- ↑ Siersema PD (2008). "Treatment options for esophageal strictures". Nat Clin Pract Gastroenterol Hepatol. 5 (3): 142–52. doi:10.1038/ncpgasthep1053. PMID 18250638.
- ↑ Yang CW, Lin HH, Hsieh TY, Chang WK (2015). "Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study". BMC Palliat Care. 14: 58. doi:10.1186/s12904-015-0056-5. PMC 4635529. PMID 26542798.
- ↑ Csendes A, Braghetto I (1992). "Surgical management of esophageal strictures". Hepatogastroenterology. 39 (6): 502–10. PMID 1483661.